Discussion
GERD, fracture, TEAEs, erosions, hypomagnesemia, reflux disease, NERD, community-acquired pneumonia, Barrett’s esophagus, esophageal and extraesophageal symptoms, gastric acid
ADVERSE EVENTS, GERD, HYPOMAGNESEMIA, CLOSTRIDIUM DIFFICILE INFECTION, COMMUNITY-ACQUIRED PNEUMONIA, COMPLICATIONS
The goal of GERD treatment is to alleviate symptoms and prevent complications. Although currently approved delayed-release PPIs have shown benefits in the treatment of GERD, unmet needs remain [Although a new class of drugs, such as potassium-competitive acid blockers (P-CABs), has recently been developed, PPIs remain the first-line drug for GERD treatment [The spectrum of GERD includes EE, nonerosive reflux disease (NERD), and Barrett’s esophagus. EE is characterized by the presence of erosions in the esophageal mucosa and is commonly graded using the LA Classification system, which has a high level of inter-observer reliability among experienced endoscopists [GERD has a significant impact on the quality of life of affected individuals, as both esophageal and extraesophageal symptoms can be bothersome and affect daily functioning [Nocturnal symptoms of GERD can significantly disrupt sleep and reduce the quality of life in patients with GERD. Nocturnal acid breakthrough (NAB), a trop in gastric pH below 4 that lasts for more than 1 h during night, is the main cause of nocturnal symptoms in patients with GERD. NAB presents in a high proportion (75%) of healthy subjects, and a once-daily dose of PPIs, owing to their short half-life, could not eliminate this phenomenon [In addition to effectiveness, the safety of new drugs remains an important issue. Recent reports have highlighted the potential long-term adverse events associated with gastric acid suppression, such as community-acquired pneumonia, clostridium difficile infection, hip fracture, or hypomagnesemia [This study has several limitations. First, most enrolled patients had LA Classification grades A/B EE, with only a small number having LA Classification grades C/D EE. None of the patients had LA grade D EE. Consequently, these findings may not represent the clinical effects in the entire GERD population, particularly in those with more severe EE. Secondly, validated questionnaires specifically designed to assess the severity and improvement of GERD symptoms were not included. However, we analyzed the severity and improvement of GERD symptoms using objective indicators, and the improvement in GERD symptoms was assessed based on dichotomous endpoints (complete resolution or not). Third, the analysis of the complete resolution of GERD symptoms and TEAEs by week 8 was limited to a small subgroup of 15 patients who did not achieve complete healing of the EE at week 4.