Risk factors for relapse of erosive GERD during long-term maintenance treatment with proton pump inhibitor: a prospective multicenter study in Japan

Background Despite low gastric acid secretion levels among elderly people and Helicobacter pylori-positive individuals in Japan, many patients suffer from endoscopic relapse of erosive gastroesophageal reflux disease (GERD) during standard-dose proton pump inhibitor (PPI) maintenance therapy. We aimed to investigate the relapse rate and risk factors for relapse during long-term PPI therapy in a prospective multicenter study. Methods Patients diagnosed endoscopically as having erosive GERD according to the Los Angeles (LA) classification, with remission under PPI medication, and without mucosal damage in the esophagus, were enrolled and took rabeprazole 10 mg/day, the standard dose in Japan, for up to 104 weeks, with endoscopy at weeks 24, 52, 76, and 104; erosive GERD with LA classification grade A, B, C, or D was defined as relapse. Results The baseline status of the 191 cases analyzed was: female (34.6%), ≥65 years old (50.8%), H. pylori-positive (40.8%), body mass index (BMI) ≥25 kg/m² (35.6%), and hiatus hernia (79.6%). Relapse occurred by week 104 in 21 cases (11%; 12 females, 9 males). Risk factors were hiatus hernia; severe past erosive GERD (grade C or D); H. pylori-negative; no mucosal atrophy; nonsmoking; and being female and