Presentation (CTI)

OBJECTIVES: Severe erosive oesophagitis (Los Angeles grade C/D) causes debilitating symptoms despite proton pump inhibitor (PPI) therapy. Approximately one-third of patients remain unhealed after 8 weeks of treatment, while 20-30% of initially healed patients relapse within 12 months. This research quantifies the clinical burden and economic impact of persistent unhealed severe erosive oesophagitis in the UK healthcare system.
METHODS: A systematic literature review identified evidence on clinical and economic burden of unhealed severe erosive oesophagitis. Multiple databases (PubMed, Embase, Cochrane Library) were searched using predefined strategies combining terms related to severe erosive oesophagitis, treatment failure, healing rates, and economic outcomes. Studies reporting LA grade C/D healing rates, relapse patterns, healthcare utilization, and costs were included. Quality assessment used critical appraisal tools. Economic data was adjusted to current UK prices.
RESULTS: Patients with unhealed severe erosive oesophagitis experience substantial burden across multiple domains. Healthcare resource utilization is significant, with patients requiring specialist referral for advanced management and 60-80% in need of surgical intervention. Health-related quality of life is markedly impaired with utility values as low as 0.56. Long-term complications include iron-deficiency anaemia (11% lifetime risk), oesophageal stricture formation (6.6% lifetime), and Barrett's oesophagus (5.2% per patient-year). Barrett's oesophagus requires lifelong surveillance and carries malignant transformation risk, generating substantial costs including surgical resection, endoscopic therapy, chemotherapy, and palliative care.
CONCLUSIONS: Unhealed severe erosive oesophagitis represents critical unmet clinical need with far-reaching consequences. Despite optimization strategies including double-dose PPI therapy, substantial patient populations remain refractory to current treatments. Treatment failure rates translate into considerable clinical and economic burden through specialist referrals, surgical interventions, quality of life impairment, and long-term complications. These findings underscore the urgent need for therapeutic alternatives beyond conventional PPI approaches. The economic case for investing in improved treatments is compelling given high costs associated with treatment failure and complications.