Severe Gastro-oesophageal Reflux Disease

A 60-year-old woman with an unremarkable medical history complained of a retrosternal burning sensation, heartburn and regurgitation, with twice-monthly symptoms evolving over 10 years. Upper digestive endoscopy (UDE) showed the lower oesophageal lumen to be reduced in diameter, with bleeding, longitudinal ulcers covering the oesophageal circumference, compatible with a diagnosis of Los Angeles class D severe erosive gastro-oesophageal reflux disease. Oral pantoprazole 40mg every 12 hours was prescribed. Symptoms of pyrosis and intermittent dysphagia resolved after 8 weeks’ treatment and repeat UDE showed the terminal portion of the oesophageal lumen to be of normal calibre with the presence of a small, hardened ulcer. The patient continued to receive maintenance therapy with once-daily pantoprazole 40 mg. Effective 24-hour control of intra-oesophageal pH at levels >4 is necessary for the treatment of oesophageal acid gastric reflux; proton pump inhibitors are currently the gold standard enabling long-term symptom control and reversal of endoscopic lesions.