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Supplementation of Los Angeles classification with esophageal mucosa index of hemoglobin can predict the treatment response of erosive reflux esophagitis

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Abstract

Background

We assessed whether the esophageal mucosa index of hemoglobin (IHb) could assist the Los Angeles (LA) classification in defining the severity of erosive reflux esophagitis (RE) and predicting the treatment response by esomeprazole.

Methods

Five hundred twenty-four subjects (424 RE and 100 controls) with normal body mass index and hemoglobin had undergone endoscopy to confirm the RE grade by LA classification and to check the series of IHb values at every centimeter of the esophageal mucosa while withdrawing the endoscope to above the esophageal–gastric junction (EGJ). The RE cases had received esomeprazole for 8 weeks (40 mg/day) to assess the cumulative proportions of sustained symptomatic response (SSR).

Results

The IHb value at the EGJ was higher in RE patients than in controls (P < 0.001). Selecting 70 as the cutoff IHb value at the EGJ, the efficacy to define RE achieved 95.8% (406/424) sensitivity and 94% (94/100) specificity. For the patients with same the LA grade, the length of IHb value >70 above the EGJ (L-IHb70) that is greater than 4 cm correlated with a poor cumulative rate of SSR (P < 0.01).

Conclusion

The IHb value >70 at the EGJ is a reliable indicator of RE. The L-IHb70 can serve as a supplementary indicator to predict the response to esomeprazole index within the same LA grade.

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Acknowledgment

This work was supported by grants NHRI-EX99-9908BI from the National Health Research Institute and DOH99-TD-C-111-003 from the Department of Health, Taiwan.

Disclosures

Drs. H. Cheng, Dr. Y.-C. Tsai, W.-Y. Chen, W.-L. Chang, H.-C. Cheng, and B.-S. Sheu have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Internal Medicine, National Cheng Kung University Medical Center, 138 Sheng Li Road, Tainan, 70428, Taiwan, ROC

    Hsin Cheng, Yu-Ching Tsai, Wei-Ying Chen, Wei-Lun Chang, Hsiu-Chi Cheng & Bor-Shyang Sheu

  2. Institute of Clinical Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, ROC

    Hsin Cheng, Yu-Ching Tsai, Wei-Ying Chen, Wei-Lun Chang, Hsiu-Chi Cheng & Bor-Shyang Sheu

Authors
  1. Hsin Cheng
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  2. Yu-Ching Tsai
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  3. Wei-Ying Chen
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  4. Wei-Lun Chang
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  5. Hsiu-Chi Cheng
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  6. Bor-Shyang Sheu
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Corresponding author

Correspondence to Bor-Shyang Sheu.

Additional information

H. Cheng and Y.-C. Tsai contributed equally to this work.

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Cheng, H., Tsai, YC., Chen, WY. et al. Supplementation of Los Angeles classification with esophageal mucosa index of hemoglobin can predict the treatment response of erosive reflux esophagitis. Surg Endosc 25, 2478–2486 (2011). https://doi.org/10.1007/s00464-010-1569-x

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