AIMS: This study assessed the endoscopic healing rates of reflux esophagitis with Los Angeles grades C and D (RE-CD) using a 6-month esomeprazole and the demographic factors or genotypes of S-mephenytoin 4′-hydroxylase (CYP2C19) that correlated with the healing of RE-CD. METHODS: One hundred thirteen patients with RE-CD received esomeprazole 40 mg daily for 6 months and completed serial follow-ups regarding healing by endoscopies at the 1st month and the 6th month, respectively. In each patient, demographic factors, including body mass index (BMI), and the CYP2C19 genotypes were checked. RESULTS: The endoscopic healing rates of RE-CD were similar among patients with different genotypes of CYP2C19 at the 1st month and the 6th month, respectively (P > 0.05). A lower healing rate of RE-CD at the 1st month was independently related to a higher BMI > 25 kg/m2, coffee drinking, and the presence of hiatus hernia (P < 0.05), but not with the CYP2C19 genotypes. A higher BMI > 25 kg/m2 independently had a 2.32-fold decrease of the healing of RE-CD (P < 0.001), but a net decrease of BMI > 1.5 kg/m2 independently had a 3.65-fold increase of the healing of RE-CD at the 6th month (P = 0.014). CONCLUSIONS: Esomeprazole 40 mg daily can be effective for RE-CD patients with different CYP2C19 genotypes. BMI > 25 kg/m2 is an independent risk factor to determine the healing of RE-CD by esomeprazole. Reducing BMI > 1.5 kg/m2, especially for those with an initial BMI > 25 kg/m2, could be promising to improve the healing of RE-CD by esomeprazole.
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