Three- to 4.5-year prospective study of prognostic indicators in gastro-oesophageal reflux disease.
BACKGROUND
Data on the long-term natural history of gastro-oesophageal reflux disease (GORD) are sparse. This prospective study was designed to determine the clinical outcome on the basis of therapeutic requirements 3 to 4.5 years after initial diagnosis of GORD and to identify specific prognostic indicators of a poor outcome.


METHODS
One hundred and one GORD patients were followed up by symptomatic questionnaire 3 to 4.5 years after diagnosis and offered repeat investigation with endoscopy and oesophageal pH monitoring if symptoms persisted.


RESULTS
Seventy-seven (76%) patients responded (mean follow-up period, 39 months; range, 32-54 months); of these, 28 had grade-II or -III oesophagitis at initial endoscopy, 17 had normal endoscopy but abnormal pH monitoring, and 32 had normal investigations but frequent heartburn. At follow-up 32 (42%) were taking acid suppression therapy, and a further 15 patients started acid suppression therapy after repeat investigation indicated a need to do so, giving a total of 47 (61%) patients receiving acid suppression. The following factors predicted a need for acid suppression at follow-up: oesophagitis on initial endoscopy (P = 0.009), abnormal pH monitoring (P = 0.0005), increased age (P < 0.0005), and increased body mass index (BMI) (P = 0.001). Gender, smoking status, alcohol intake, and lower oesophageal sphincter pressure had no prognostic value. Regression analysis confirmed that age (P = 0.0007), BMI (P = 0.04), and endoscopy result (P = 0.04) all independently affected outcome.


CONCLUSIONS
Most GORD patients still require acid suppression therapy 3 to 4.5 years after initial diagnosis. Age, BMI, and presence of oesophagitis at initial endoscopy all independently predict those who will require long-term acid suppression therapy.
McDougall
N I
NI
Dept. of Medicine, The Queen's University of Belfast, Royal Victoria Hospital, Northern Ireland.
Johnston
B T
BT
Collins
J S
JS
McFarland
R J
RJ
Love
A H
AH
D000328:Adult; D000367:Age Factors; D000863:Antacids / Q000627:therapeutic use; D015992:Body Mass Index; D016022:Case-Control Studies; D004942:Esophagitis, Peptic / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000453:epidemiology*; D006356:Heartburn / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
D000863:Antacids