Systematic review: persistence and severity in gastro-oesophageal reflux disease.
BACKGROUND
Management strategies for gastro-oesophageal reflux disease (GERD) are often inconsistent with the proposition that it is a persistent or chronic disease.


OBJECTIVE
To determine the persistence of reflux symptoms and complications associated with GERD.


METHODS
Systematic searches of Medline and EMBASE.


RESULTS
In longitudinal studies, 65% (95% CI 54-75%) of patients with complicated GERD and 70% (95% CI 57-83%) of patients with 'defined' GERD had persistent disease at follow-up, whereas 34% (95% CI 27-40%) with infrequent or mild reflux symptoms at baseline had persistent symptoms. Clinical trials of maintenance treatment for at least 6 months after healing of oesophagitis reported mean relapse rates of 75% (95% CI 68-82%) in patients taking placebo and 28% (95% CI 21-35%) in those taking proton pump inhibitors. Retrospective studies reported that 34-41% of individuals with GERD recalled experiencing their symptoms for >10 years. The prevalence of GERD is high (10-20%), whereas the incidence is low (4.5-19.6 cases per 1000 person-years), suggesting that GERD is likely to persist for at least 18 years.


CONCLUSIONS
Individuals with GERD have persistent reflux symptoms that merit management as a chronic disease; infrequent reflux symptoms are less likely to be chronic and may respond to different management strategies.
Armstrong
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Division of Gastroenterology, McMaster University, Hamilton, ON, Canada. armstro@mcmaster.ca
D002908:Chronic Disease; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000378:metabolism; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D015995:Prevalence
D005765:Gastrointestinal Agents