Symptomatic and endoscopic outcome of heartburn 3-4.5 years after starting lansoprazole therapy: a prospective study of 142 patients.

Background: Heartburn is a common symptom with great impact on quality of life and on the economy. An approach that helps to alleviate patients' symptoms, decrease the burden on the economy, and improve longterm outcome is needed. Step-down therapy, starting with the proton pump inhibitor lansoprazole, seems to achieve these goals.

Methods: All patients who were referred to the gastroenterology clinic at the University Health Center to evaluate their heartburn and who met the inclusion criteria were included in the present study. Symptomatic and endoscopic evaluations were carried out and then they were started on the proton pump inhibitor lansoprazole to achieve symptomatic control. Step-down therapy was carried out for these patients, provided their symptoms remained controlled. At the end of the study symptomatic and endoscopic outcomes were evaluated.

Results: Heartburn was controlled on lansoprazole 30 mg/per day in 76.1% of patients, and 18.3% required double this dose. Initial endoscopy showed normal findings in 38.7%, while 61.3% showed various grades of esophagitis including 1.4% with Barrett's epithelium. Of 119 patients who completed the study, 17 were non-compliant to therapy, 52 were controlled on minimal therapy, 42 required lansoprazole to be kept symptom-free, and 8 patients had surgery. Endoscopic esophagitis was healed or attenuated in all compliant patients. No new cases of Barrett's appeared during follow up.

Conclusions: Most of the patients with heartburn can be controlled on proton pump inhibitors, with improvement in the grade of endoscopic esophagitis. Half of these patients can be kept on minimal therapy after a period of 3-4.5 years with maintenance of improvement, while the remainder still need proton pump inhibitors for control.