title: Clinical characteristics and natural history of patients with low-grade reflux esophagitis.
abstract: OBJECTIVE
  Although the incidence of reflux esophagitis (RE) has recently increased in Japan, the majority of these cases are mild (Los Angeles classification grades A and B). In order to consider therapy for these patients, it is important to understand the natural history of mild RE. There is little information concerning the natural course of RE, particularly low-grade disease. The goal of this study is to elucidate the natural course of patients with mild RE and to identify specific prognostic indicators associated with a poor outcome.
  
  
  METHODS
  One hundred and five patients with mild RE were followed, without medical treatment, by endoscopy in addition to a questionnaire regarding symptomatology, for a mean of 5.5 years (range, 2.0-8.8 years) after initial diagnosis. Factors associated with the development of severe esophagitis were analyzed.
  
  
  RESULTS
  Endoscopically, 11 patients (10.5%) progressed to more severe forms of RE (recurrent progressive (RP) group), 60.0% of patients relapsed without disease progression (recurrent non-progression group), and the remaining 29.5% of patients had no further episodes of RE (isolated episode group). Risk factors for progressive disease were increased age, female sex, the presence of symptoms at initial diagnosis by endoscopy, presence of a hiatal hernia, absence of atrophic gastritis, and absence of Helicobacter pylori infection. Despite having all risk factors, there were six patients who did not progress to more severe forms of RE. The primary esophageal peristaltic amplitude in these patients was significantly higher than in the RP group.
  
  
  CONCLUSIONS
  Among patients with mild RE, only 10.5% progressed to more severe forms of RE. The patients with risk factors are candidates for aggressive therapy in order to prevent the progression of the RE disease process.
authors.affiliation: Gastrointestinal Unit, First Department of Internal Medicine, Hiroshima University School of Medicine, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Manabe
authors.forename: Masaharu
authors.initials: M
authors.lastname: Yoshihara
authors.forename: Atsunori
authors.initials: A
authors.lastname: Sasaki
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.forename: Ken
authors.initials: K
authors.lastname: Haruma
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000368:Aged; D018450:Disease Progression; D004942:Esophagitis, Peptic / Q000175:diagnosis* / Q000382:microbiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000382:microbiology / Q000503:physiopathology; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000175:diagnosis / Q000382:microbiology / Q000503:physiopathology; D016480:Helicobacter pylori; D006551:Hernia, Hiatal / Q000175:diagnosis; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires