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Natural history of gastro-oesophageal reflux disease without oesophagitis (NERD)--a reappraisal 10 years on.

Abstract

BACKGROUND AND AIM

Ten years ago we published a study describing the 6-month outcome of 33 outpatients with typical gastro-oesophageal reflux disease symptoms and pH-metry proven excess gastro-oesophageal reflux but without endoscopical evidence of oesophagitis, currently referred to as patients with gastro-oesophageal reflux disease without oesophagitis. We now present an update of that report concerning morbidity, drug consumption and quality of life of the original patients 10 years after the initial diagnosis.

METHODS

The study consisted of the retrieval and revision of all clinical and instrumental records concerning the cohort of 33 above-mentioned patients. Data are available regarding annual intervals within the first 5 years from original diagnosis and, subsequently, with a follow-up ranging from 7 to 14 years (median 10 years). The records of these 33 patients were reviewed, including the results of clinical visits at the outpatients department, of oesophagogastroduodenoscopies and pH- metries. Finally, a telephonic interview was conducted by means of a structured questionnaire, aiming at evaluating present symptoms, actual therapy if any, health-related quality of life and other information regarding any gastro-oesophageal reflux disease symptoms.

RESULTS

Of the original 33 patients, 31 are still alive and 2 were lost to follow-up. Of the 29 remaining, only 1 is definitively not complaining of any gastro-oesophageal reflux disease-related symptoms. Within 5 years of the first diagnosis, oesophagitis was found in all but one of the 18 subjects who underwent repeated endoscopy. At the latest follow-up check, after a median of 10 years, out of the 28 still complaining of gastro-oesophageal reflux disease symptoms, 21 (75%) were presently taking antisecretory drugs (proton pump inhibitors and H-2 receptor antagonists) because of gastro-oesophageal reflux disease symptoms/lesions, 12 of whom intermittently or on demand and the remaining 9 continuously. Two patients (2/28) underwent antireflux surgery, but despite this were still taking antisecretory drugs (in one case H2-RA; in the other proton pump inhibitor). The health-related quality of life, self-evaluated by the patient by means of a VAS scoring from 0 (worst possible) to 10 (best possible) increased significantly from 3.2 to 6.5 from baseline (before therapy) to present time, possibly due to the positive effect of present therapy.

CONCLUSIONS

Our study conducted on a cohort of endoscopy-negative patients with pH-metry-confirmed reflux disease has shown that after a median time of 10 years following the original diagnosis, the majority of patients have, in fact, developed reflux oesophagitis and are on prolonged antisecretory therapy because of recurrent gastro-oesophageal reflux disease symptoms/lesions. The study confirms that gastro-oesophageal reflux disease without oesophagitis, as well as gastro-oesophageal reflux disease at large, is a chronic disease characterised by increasing severity with time, which requires protracted medical therapy in a vast proportion of patients. Absence of endoscopic oesophagitis at presentation does not represent a positive prognostic factor.

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  • Authors+Show Affiliations

    ,

    Chair of Gastroenterology, University Hospital "L. Sacco", Via G.B. Grassi 74, I-20157 Milan, Italy.

    , ,

    Source

    MeSH

    Cohort Studies
    Disease Progression
    Esophagitis
    Female
    Follow-Up Studies
    Gastroesophageal Reflux
    Humans
    Hydrogen-Ion Concentration
    Male
    Middle Aged
    Outcome Assessment (Health Care)
    Quality of Life
    Severity of Illness Index
    Time Factors

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    15002817

    Citation

    Pace, F, et al. "Natural History of Gastro-oesophageal Reflux Disease Without Oesophagitis (NERD)--a Reappraisal 10 Years On." Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, vol. 36, no. 2, 2004, pp. 111-5.
    Pace F, Bollani S, Molteni P, et al. Natural history of gastro-oesophageal reflux disease without oesophagitis (NERD)--a reappraisal 10 years on. Dig Liver Dis. 2004;36(2):111-5.
    Pace, F., Bollani, S., Molteni, P., & Bianchi Porro, G. (2004). Natural history of gastro-oesophageal reflux disease without oesophagitis (NERD)--a reappraisal 10 years on. Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 36(2), pp. 111-5.
    Pace F, et al. Natural History of Gastro-oesophageal Reflux Disease Without Oesophagitis (NERD)--a Reappraisal 10 Years On. Dig Liver Dis. 2004;36(2):111-5. PubMed PMID: 15002817.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Natural history of gastro-oesophageal reflux disease without oesophagitis (NERD)--a reappraisal 10 years on. AU - Pace,F, AU - Bollani,S, AU - Molteni,P, AU - Bianchi Porro,G, PY - 2004/3/9/pubmed PY - 2004/5/12/medline PY - 2004/3/9/entrez SP - 111 EP - 5 JF - Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver JO - Dig Liver Dis VL - 36 IS - 2 N2 - BACKGROUND AND AIM: Ten years ago we published a study describing the 6-month outcome of 33 outpatients with typical gastro-oesophageal reflux disease symptoms and pH-metry proven excess gastro-oesophageal reflux but without endoscopical evidence of oesophagitis, currently referred to as patients with gastro-oesophageal reflux disease without oesophagitis. We now present an update of that report concerning morbidity, drug consumption and quality of life of the original patients 10 years after the initial diagnosis. METHODS: The study consisted of the retrieval and revision of all clinical and instrumental records concerning the cohort of 33 above-mentioned patients. Data are available regarding annual intervals within the first 5 years from original diagnosis and, subsequently, with a follow-up ranging from 7 to 14 years (median 10 years). The records of these 33 patients were reviewed, including the results of clinical visits at the outpatients department, of oesophagogastroduodenoscopies and pH- metries. Finally, a telephonic interview was conducted by means of a structured questionnaire, aiming at evaluating present symptoms, actual therapy if any, health-related quality of life and other information regarding any gastro-oesophageal reflux disease symptoms. RESULTS: Of the original 33 patients, 31 are still alive and 2 were lost to follow-up. Of the 29 remaining, only 1 is definitively not complaining of any gastro-oesophageal reflux disease-related symptoms. Within 5 years of the first diagnosis, oesophagitis was found in all but one of the 18 subjects who underwent repeated endoscopy. At the latest follow-up check, after a median of 10 years, out of the 28 still complaining of gastro-oesophageal reflux disease symptoms, 21 (75%) were presently taking antisecretory drugs (proton pump inhibitors and H-2 receptor antagonists) because of gastro-oesophageal reflux disease symptoms/lesions, 12 of whom intermittently or on demand and the remaining 9 continuously. Two patients (2/28) underwent antireflux surgery, but despite this were still taking antisecretory drugs (in one case H2-RA; in the other proton pump inhibitor). The health-related quality of life, self-evaluated by the patient by means of a VAS scoring from 0 (worst possible) to 10 (best possible) increased significantly from 3.2 to 6.5 from baseline (before therapy) to present time, possibly due to the positive effect of present therapy. CONCLUSIONS: Our study conducted on a cohort of endoscopy-negative patients with pH-metry-confirmed reflux disease has shown that after a median time of 10 years following the original diagnosis, the majority of patients have, in fact, developed reflux oesophagitis and are on prolonged antisecretory therapy because of recurrent gastro-oesophageal reflux disease symptoms/lesions. The study confirms that gastro-oesophageal reflux disease without oesophagitis, as well as gastro-oesophageal reflux disease at large, is a chronic disease characterised by increasing severity with time, which requires protracted medical therapy in a vast proportion of patients. Absence of endoscopic oesophagitis at presentation does not represent a positive prognostic factor. SN - 1590-8658 UR - https://www.unboundmedicine.com/medline/citation/15002817/Natural_history_of_gastro_oesophageal_reflux_disease_without_oesophagitis__NERD___a_reappraisal_10_years_on_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1590-8658(03)00639-X DB - PRIME DP - Unbound Medicine ER -