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Outcome of nonerosive gastro-esophageal reflux disease patients with pathological acid exposure

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Author(s): Fabio Pace, Stefano Pallotta, Gianpiero Manes, Annalisa de Leone, Patrizia Zentilin, Luigi Russo, Vincenzo Savarino, Matteo Neri, Enzo Grossi, Rosario Cuomo

Journal: World Journal of Gastroenterology
ISSN 1007-9327

Volume: 15;
Issue: 45;
Start page: 5700;
Date: 2009;
Original page

Keywords: Esophagus | Nonerosive gastro-esophageal reflux disease | Gastro-esophageal reflux disease | Epidemiology | Acidity

ABSTRACT
AIM: To assess the management and outcome of nonerosive gastro-esophageal reflux disease (NERD) patients who were identified retrospectively, after a 5-year follow-up.METHODS: We included patients with gastro-esophageal reflux disease (GERD) symptoms who had a negative endoscopy result and pathological 24-h esophageal pH-monitoring while off therapy. We interviewed them after an average period of 5 years (range 3.5-7 years) by means of a structured questionnaire to assess presence of GERD symptoms, related therapy, updated endoscopic data and other features. We assessed predictors of esophagitis development by means of univariate and multivariate statistical analysis.RESULTS: 260 patients (137 women) were included. Predominant GERD symptoms were heartburn and regurgitation in 103/260 (40%). 70% received a maintenance treatment, which was proton pump inhibitor (PPI) in 55% of cases. An average number of 1.5 symptomatic relapses per patient/year of follow-up were observed. A progression to erosive gastro-esophageal reflux disease (ERD) was found in 58/193 (30.0%) of patients undergoing repeat endoscopy; 72% of these were Los Angeles grade A-B.CONCLUSION: This study shows that progression to ERD occurs in about 5% of NERD cases per year, despite therapy. Only two factors consistently and independently influence progression: smoking and absence of PPI therapy.

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