The impact of body mass index on the application of on-demand therapy for Los Angeles grades A and B reflux esophagitis

Am J Gastroenterol. 2007 Nov;102(11):2387-94. doi: 10.1111/j.1572-0241.2007.01468.x.


Background and aims: Patients with Los Angeles grade A or B reflux esophagitis (RE-AB) can potentially be switched from active-phase therapy to on-demand esomeprazole as maintenance therapy. Body mass index (BMI) correlates significantly with reflux symptoms. We investigated whether BMI affects the efficacy of esomeprazole in active-phase or subsequent on-demand therapy.

Methods: Three hundred fifty patients with RE-AB were prospectively enrolled to receive an 8-wk course of esomeprazole (40 mg/day) as active-phase therapy. Based on the daily severity of acid regurgitation and heartburn, the cumulative proportions of patients with sustained symptomatic response (SSR), defined as free from symptoms for the last 7 days, were compared among different BMI groups (control: BMI <25 kg/m2, overweight: BMI 25-30 kg/m2, obese: BMI >30 kg/m2). In patients who had achieved SSR by week 8, on-demand therapy for 2 months was started. The number of 40-mg esomeprazole tablets used per 4-wk period was recorded.

Results: SSR rates were lower in both the overweight and obese groups than in the control group (P < 0.001). During on-demand therapy, the mean number of tablets used per 4-wk period was lower in the control group than in either the overweight or the obese group (13.2 vs 15.3 or 16.2, P < 0.05). The failure rate of on-demand therapy increased with increasing BMI-2.4%, 5.3%, and 14.2%, respectively, for the control, overweight, and obese groups (P= 0.002).

Conclusion: For RE-AB, a higher BMI decreases the rate of SSR after 8-wk of esomeprazole therapy, and increases the need for medication and the failure rate of on-demand therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analysis of Variance
  • Anti-Ulcer Agents / therapeutic use*
  • Body Mass Index*
  • Dose-Response Relationship, Drug
  • Esomeprazole / therapeutic use*
  • Esophagitis, Peptic / drug therapy*
  • Esophagitis, Peptic / pathology
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Prospective Studies
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Treatment Outcome


  • Anti-Ulcer Agents
  • Esomeprazole