What are the presentations of esophagitis and gastritis?

From the Guidelines

Esophagitis and gastritis present with distinct but sometimes overlapping symptoms, and the most recent guidelines recommend a step-up approach for management, starting with proton pump inhibitors and lifestyle modifications. The presentation of esophagitis and gastritis can vary, with esophagitis typically manifesting as heartburn, painful swallowing (odynophagia), difficulty swallowing (dysphagia), chest pain that may mimic cardiac issues, and regurgitation of food or sour liquid 1. Gastritis commonly presents with upper abdominal pain or discomfort, nausea, vomiting, bloating, indigestion, and occasionally hematemesis (vomiting blood) or melena (black, tarry stools) if bleeding occurs.

Some key points to consider in the management of esophagitis and gastritis include:

• The use of proton pump inhibitors (PPIs) such as omeprazole 20-40mg daily or pantoprazole 40mg daily for 4-8 weeks as initial management, along with lifestyle modifications including avoiding trigger foods (spicy, acidic, fatty), alcohol, smoking, and eating smaller meals 1.
• H2 blockers such as famotidine 20mg twice daily can be used as alternatives for patients who cannot tolerate PPIs or have contraindications to their use 1.
• If H. pylori infection is suspected in gastritis, triple therapy consisting of a PPI, amoxicillin 1g twice daily, and clarithromycin 500mg twice daily for 14 days is indicated 1.
• Endoscopy is warranted for persistent symptoms, alarm features (weight loss, anemia, dysphagia), or age over 55 years to rule out more serious conditions like Barrett's esophagus or malignancy 1.

The most recent guidelines recommend a step-up approach for management, starting with PPIs and lifestyle modifications, and escalating to more intensive therapy or endoscopy as needed 1. It is essential to consider the patient's symptoms, medical history, and risk factors when determining the best course of management.

In terms of specific symptoms, dysphagia and food bolus obstruction are strongly associated with a diagnosis of eosinophilic oesophagitis, and patients with these symptoms should be evaluated for this condition 1. Additionally, reflux symptoms and chest pain are less common in eosinophilic oesophagitis but may be the presenting symptoms in some patients.

Overall, the management of esophagitis and gastritis requires a comprehensive approach that takes into account the patient's symptoms, medical history, and risk factors, and involves a step-up approach with PPIs, lifestyle modifications, and endoscopy as needed.

From the FDA Drug Label

In a U. S multi-center, double-blind, placebo-controlled study of 269 patients entering with an endoscopic diagnosis of esophagitis with mucosal grading of two or more and grades three and four signifying erosive disease, the percentages of patients with healing are presented in Table 18: Table 18: Erosive Esophagitis Healing Rates Lansoprazole 15 mg daily 30 mg daily 60 mg daily Placebo (N=63) Week (N=69) (N=65) (N=72) 4 67.6% * 81.3% * † 80.6% * † 32.8% 6 87.7% * 95.4% * 94.3% * 52.5% 8 90.9% * 95.4% * 94.4% * 52.5%

• (p≤ 0.001) vs placebo. † (p≤ 0. 05) vs lansoprazole 15 mg.

The presentation of esophagitis and gastritis can be characterized by symptoms such as heartburn, abdominal pain, and difficulty swallowing.

• Erosive esophagitis is a condition where the esophagus is inflamed and eroded, and can be diagnosed through endoscopy.
• Gastritis is a condition where the stomach lining is inflamed, and can be caused by a variety of factors, including NSAID use. The healing rates for erosive esophagitis were significantly higher in patients treated with lansoprazole compared to placebo, with healing rates ranging from 67.6% to 95.4% depending on the dose and duration of treatment 2. In patients with symptomatic GERD, lansoprazole was effective in reducing the frequency and severity of heartburn and other symptoms, with significant improvements observed in patients treated with 15 mg daily and 30 mg daily doses 2. It is essential to note that the effectiveness of lansoprazole in treating esophagitis and gastritis may vary depending on the individual patient and the specific condition being treated. Therefore, it is crucial to consult with a healthcare professional for proper diagnosis and treatment.

From the Research

Presentation of Esophagitis and Gastritis

• Esophagitis and gastritis are conditions that can be effectively treated with proton pump inhibitors (PPIs) 3, 4, 5, 6, 7
• The presentation of esophagitis can vary, with symptoms including heartburn, acid regurgitation, and epigastric pain 4, 7
• Gastritis, on the other hand, can present with symptoms such as abdominal pain, nausea, and vomiting 3

Treatment Options

• Omeprazole is a well-studied PPI that has been shown to be effective in treating esophagitis and gastritis 3
• Other PPIs, such as lansoprazole, pantoprazole, and rabeprazole, have also been shown to be effective in treating these conditions 4, 5, 6, 7
• The choice of PPI may depend on the severity of the condition, as well as the patient's response to treatment 5, 7

Efficacy of PPIs

• Studies have shown that PPIs are effective in healing esophagitis and preventing relapse 3, 4, 5, 6, 7
• The efficacy of PPIs can vary, with some studies showing that certain PPIs are more effective than others in certain patient populations 5, 7
• For example, pantoprazole and rabeprazole have been shown to be more effective than omeprazole in healing esophagitis in elderly patients 7

Patient Factors

• Patient factors, such as age and presence of H. pylori infection, can influence the efficacy of PPIs 3, 7
• However, studies have shown that PPIs can be effective in treating esophagitis and gastritis in patients with and without H. pylori infection 3, 7