Clinical trial: factors associated with resolution of heartburn in patients with reflux oesophagitis – results from the EXPO study


Dr J. Labenz, Medical Department, Ev. Jung-Stilling Hospital, Wichernstr. 40, D-57074 Siegen, Germany.


Background  The ability to predict symptom response to reflux oesophagitis-healing therapy may optimize treatment decisions.

Aim  To identify factors associated with heartburn resolution in patients receiving acid-suppressive therapy for reflux oesophagitis.

Methods  In this multicentre, randomized, double-blind trial (EXPO; AstraZeneca study code: SH-NEG-0008), patients with endoscopically confirmed reflux oesophagitis and reflux symptoms received once-daily proton pump inhibitor therapy [esomeprazole 40 mg (= 1562) or pantoprazole 40 mg (= 1589)] for ≥4 weeks. Factors associated with heartburn resolution after 4 weeks were identified by multiple logistic regression analysis.

Results  Esomeprazole therapy, positive Helicobacter pylori status and greater age were associated with an increased likelihood of heartburn resolution [odds ratio (95% confidence interval): 1.31 (1.12, 1.54), 1.44 (1.19, 1.74) and 1.013 (1.007, 1.019) per year, respectively; all < 0.001]. Men and patients with no acid regurgitation or epigastric pain pre-treatment were also more likely to achieve heartburn resolution (all < 0.05).

Conclusions  The use of esomeprazole rather than pantoprazole increases the probability of achieving resolution of heartburn during reflux oesophagitis-healing therapy. Other factors, including H. pylori status, age, gender and symptom profile may be helpful in determining the likelihood of heartburn resolution in such patients.