Erosive esophagitis and h pylori: acid reflux inside an outline of the esophagus and the stomach

Erosive esophagitis recurring despite treatment? Optimizing acid suppression could help.1-5

Investigate these 4 unmet
needs in erosive esophagitis.

1

Even after stopping treatment, erosive esophagitis frequently returns.1-4

infographic showing that erosive esophagitis recurs in 71 to 80% of patients 6 months after erosive esophagitis treatment ends

Up to 40% of LA Grade C or D patients relapse on a PPI maintenance treatment. Erosive esophagitis recurs in ~71-80% of patients within 6 months of PPI discontinuation.1-4,6,7

infographic showing that erosive esophagitis recurs in 71 to 80% of patients 6 months after erosive esophagitis treatment ends
2

Current acid suppression may not be adequate to maintain healing.5,8-12

erosive esophagitis: uncontrolled gastric acid about to enter the esophagus

Several factors can contribute to inadequate acid suppression:

  • Most PPIs have a short half-life of 1 to 2 hours and require food for activation
  • PPIs take about 3 days to reach a steady state of acid inhibition
  • Long-term maintenance of healing is related to the extent of acid suppression in a 24-hour period
  • Adherence issues can affect treatment efficacy. In the SOARD study (Study of Acid-Related Disorders, Perspectives From Physicians and Patients)13*:
    • 51% of patients reported not fully adhering to treatment. Of those patients, 89% forgot to take their medications at least some of the timea

aIndicates percentage of patients with a response of 2-5 on a 5-point scale that ranged from (1) “never” to (5) “all of the time” to the question “How often do you forget to take your medication?”

Learn about maintaining long-term erosive
esophagitis healing from Dr Joan Chen and
Dr Prateek Sharma.

Jump to Podcast
erosive esophagitis: uncontrolled gastric acid about to enter the esophagus
3

Erosive esophagitis treatment may not be meeting expectations.13

erosive esophagitis treatment: graphic showing three faces, one smiling, one looking neutral, and one frowning

In the SOARD study,* patients were asked about the importance of speed, efficacy, and duration of their erosive esophagitis treatments. The results showed that:

  • Only 44% of patients completely agree that their current treatment is a lasting solutiona
  • Fast healing is important to nearly 60% of patients and HCPsb
  • Better initial healing makes 70% of patients feel hopeful that the medication will resolve their problemc
erosive esophagitis treatment: graphic showing three faces, one smiling, one looking neutral, and one frowning

aPatient responses to the statement: “My current treatment is a long-lasting solution to my erosive esophagitis.”

bResponses to the statement: “Fast healing is important to me” for patients and “Faster healing is important to me” for physicians.

cPatient responses to the statement: “Better initial healing of my esophagus makes me hopeful that the treatment will resolve the problem.”

4

When erosive esophagitis persists, additional complications may arise.12,14,15

ppi and erosive esophagitis: image showing over the counter medicine for erosive esophagitis treatment

Complications may include respiratory problems, chest pain, and an increased risk of esophageal cancer. Erosive esophagitis can have similar effects on quality of life to those with chronic conditions like diabetes or depression. When erosive esophagitis symptoms are not controlled, patients will often switch PPIs, increase their dosing, or supplement with over-the-counter (OTC) treatments.12,14-19

The SOARD study* has shown that13:

  • 25% of patients take PPIs more than once dailya
  • 73% of HCPs recommended supplementing with OTC therapy at least once. However, 48% of patients would feel more satisfied if they could reduce the need to include OTC medicationsa

aIndicates percentage of patients with a response of 6 or 7 on a 7-point scale that ranged from (1) “strongly disagree” to (7) “strongly agree” to the statement: “Reducing the need to include over-the-counter therapies would increase my satisfaction.”

ppi and erosive esophagitis: image showing over the counter medicine for erosive esophagitis treatment

*SOARD (Study of Acid-Related Disorders, Perspectives From Physicians and Patients), a Phathom Pharmaceuticals‐sponsored study that surveyed 251 physicians (102 gastroenterologists, 149 primary care physicians) and 73 patients with erosive esophagitis between November 2020 and April 2021. The survey captured physician and patient perspectives on symptoms, burden of disease, treatment goals, adherence, and satisfaction. A medical chart review was conducted for all patients. The differences in physician perception and patient experience of the disease have been analyzed as well as patient demographics, clinical characteristics, and disease and treatment management.

Hear from erosive esophagitis experts

What are the barriers to erosive esophagitis healing?

Learn about the role acid suppression plays in the healing of erosive esophagitis from Dr Joan Chen and Dr Prateek Sharma.

  • Listen to a discussion with leading physicians to learn more about erosive esophagitis treatment challenges and how acid suppression affects long-term maintenance of healing
  • It’s the first episode of pHireside CHATS on erosive esophagitis: Inadequate acid suppression—a barrier to healing erosive esophagitis

Why do so many erosive esophagitis patients relapse with current treatments?

Discover the critical role acid suppression plays in the maintenance of healing of erosive esophagitis with Dr Joan Chen and Dr Nimish Vakil.

  • Up to 40% of erosive esophagitis patients relapse and about 71 to 80% experience recurrence within 6 months of stopping PPI treatment. Optimizing acid suppression may help patients maintain healing1-4,6,7
  • Listen to the second episode of pHireside CHATS on erosive esophagitis: Sustained acid suppression—a critical factor for the maintenance of healing in erosive esophagitis

Does your treatment regimen
pass the acid test?

Find Out

References:

  • 1.Katzka DA, Kahrilas PJ. Advances in the diagnosis and management of gastroesophageal reflux disease. BMJ. 20‍20;371:m37‍86 doi:10.113‍6/bmj.m3‍786
  • 2.Hetzel DJ, Dent J, Reed WD, et al. Healing and relapse of severe peptic esophagitis after treatment with omeprazole. Gastroenterology. 19‍88;95(4):9‍03-91‍2. doi:10.10‍16/0016-50‍85(88)901‍62-x
  • 3.Metz DC, Howden CW, Perez MC, Larsen L, O’Neil J, Atkinson SN. Clinical trial: dexlansoprazole MR, a proton pump inhibitor with dual delayed-release technology, effectively controls symptoms and prevents relapse in patients with healed erosive oesophagitis. Aliment Pharmacol Ther. 20‍09;29(7):74‍2-7‍54. doi:10.11‍11/j.13‍65-20‍36.20‍09.039‍54.x
  • 4.Vakil NB, Shaker R, Johnson DA, et al. The new proton pump inhibitor esomeprazole is effective as a maintenance therapy in GERD patients with healed erosive oesophagitis: a 6-month, randomized, double-blind, placebo-controlled study of efficacy and safety. Aliment Pharmacol Ther. 20‍01;15(7):92‍7-9‍35. doi:10.10‍46/j.13‍65-20‍36.20‍01.010‍24.x
  • 5.Johnson DA, Katz PO, Levine D, et al. Prevention of relapse of healed reflux esophagitis is related to the duration of intragastric pH > 4. J Clin Gastroenterol. 20‍10;44(7):47‍5-47‍8. doi:10.10‍97/MCG.0b013‍e3181d‍d9c5b
  • 6.Dickman R, Maradey- Romero C, Gingold-Belfer R, Fass R. Unmet needs in the treatment of gastroesophageal reflux disease. J Neurogastroenterol Motil. 20‍15;21(3):30‍9-319. doi:10.50‍56/jnm1‍5105
  • 7.Hershcovici T, Fass R. Pharmacological management of GERD: where does it stand now? Trends Pharmacol Sci. 20‍11;32(4):25‍8‍-‍2‍64. doi:10.10‍16/j.tips.20‍11.0‍2.00‍7
  • 8.Sachs G, Shin JM, Howden CW. Review article: the clinical pharmacology of proton pump inhibitors. Aliment Pharmacol Ther. 20‍06;23(suppl 2):2-8. doi:10.11‍11/j.13‍65-20‍36.20‍06.029‍43.x
  • 9.Shin JM, Sachs G. Pharmacology of proton pump inhibitors. Curr Gastroenterol Rep. 20‍08;10(6):52‍8-53‍4. doi:10.10‍07/s118‍94-0‍08-00‍98-4
  • 10.Solem C, Mody R, Stephens J, Macahilig C, Gao X. Mealtime-related dosing directions for proton-pump inhibitors in gastroesophageal reflux disease: physician knowledge, patient adherence. J Am Pharm Assoc (2003). 20‍14;54(2):14‍4-15‍3. doi:10.13‍31/JAPhA.20‍14.131‍17
  • 11.Mermelstein J, Mermelstein AC, Chait MM. Proton pump inhibitors for the treatment of patients with erosive esophagitis and gastroesophageal reflux disease: current evidence and safety of dexlansoprazole. Clin Exp Gastroenterol. 20‍16;9:1‍63-17‍2. doi:1‍0.21‍47/CEG.S91‍602
  • 12.Dickman R, Maradey-Romero C, Gingold- Belfer R, Fass R. Unmet needs in the treatment of gastroesophageal reflux disease. J Neurogastroenterol Motil. 20‍15;21(3):30‍9-3‍19. doi:10.50‍56/jnm15‍105
  • 13.Data on file. Phathom Pharmaceuticals, Inc. Florham Park, NJ.
  • 14.Scholten T. Long-term management of gastroesophageal reflux disease with pantoprazole. Ther Clin Risk Manag. 20‍07;3(2):23‍1-24‍3. doi:10.21‍47/tcrm.20‍07.3‍.2‍.2‍31
  • 15.Ruigómez A, García Rodríguez LA, Wallander MA, Johansson S, Graffner H, Dent J. Natural history of gastro-oesophageal reflux disease diagnosed in general practice. Aliment Pharmacol Ther. 20‍04;20(7):75‍1-76‍0. doi:10.11‍11/j.13‍65-20‍36.20‍04.021‍69.x
  • 16.Lippmann QK, Crockett SD, Dellon ES, Shaheen NJ. Quality of life in GERD and Barrett’s esophagus is related to gender and manifestation of disease. Am J Gastroenterol. 20‍09;104(11):26‍95-27‍03. doi:10.1038/ajg.20‍09.50‍4
  • 17.Quigley EMM, Hungin APS. Review article: quality-of-life issues in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 20‍05;22(suppl 1):41-47. doi:10.11‍11/j.13‍65-20‍36.20‍05.026‍08.x
  • 18.Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 20‍13;10‍8(3):30‍8-3‍28. doi:10.10‍38/ajg.20‍12.44‍4
  • 19.Chey WD, Mody R, Wu EQ, et al. Treatment patterns and symptom control patients with GERD: US community-based survey. Curr Med Res Opin. 20‍09;25(8):18‍69-18‍78. doi:10.1185/03007‍9909030‍35745

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