Course of erosive gastroesophageal reflux disease (ERD)--a prospective examination under therapeutic daily life conditions with a mean follow-up of 6.5 years.
BACKGROUND
Endoscopic screening for Barrett's esophagus is an accepted base for surveillance strategies of Barrett's esophagus; data on the natural history of erosive gastroesophageal reflux disease (ERD) are sparse. Therefore, we performed a prospective long-term follow-up examination of the course of ERD to confirm the recommendation of a once-in-lifetime endoscopy as a screening programme for Barrett's esophagus.


METHODS
Patients not older than 60 years with reflux symptoms and a first time diagnosis of ERD or Barrett's esophagus at the time of inclusion were identified. Patients were followed up by a further upper GI endoscopy after at least 5 years. They were interviewed about clinical symptoms and medication use.


RESULTS
One hundred and thirty-five patients were included. Follow-up data were obtained for 115 patients. Seventy-one patients (22 female, 49 male, average age: 48.3 years; range: 22-60 years) remained in the programme, 37 patients died from unrelated diseases within the follow-up period (mostly due to cardiovascluar diseases). Seven patients were excluded because of missing videoendoscopy. The average follow-up period was 78.3 (range: 60-85) months. During this time, 76 % of the patients received medical therapy. Only three patients (4.5 %) showed progression of erosive lesions, whereas two patients developed a short-segment Barrett's esophagus without intraepithealial neoplasia. These 5 patients received no medical therapy.


CONCLUSIONS
Progression of ERD is an unlikely event. Once-in-lifetime endoscopy is an adequate screening tool that may serve as a basis for a Barrett's esophagus surveillance program.
Hartmann
D
D
Medizinische Klinik C, Klinikum Ludwigshafen. medcluhartmann@t-online.de
Kudis
V
V
Jakobs
R
R
Riemann
J F
JF
Schilling
D
D
D000328:Adult; D001471:Barrett Esophagus / Q000175:diagnosis*; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000175:diagnosis*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity