Outcome of nonerosive gastro-esophageal reflux disease patients with pathological acid exposure.
OBJECTIVE
To assess the management and outcome of nonerosive gastro-esophageal reflux disease (NERD) patients who were identified retrospectively, after a 5-year follow-up.


METHODS
We included patients with gastro-esophageal reflux disease (GERD) symptoms who had a negative endoscopy result and pathological 24-h esophageal pH-monitoring while off therapy. We interviewed them after an average period of 5 years (range 3.5-7 years) by means of a structured questionnaire to assess presence of GERD symptoms, related therapy, updated endoscopic data and other features. We assessed predictors of esophagitis development by means of univariate and multivariate statistical analysis.


RESULTS
260 patients (137 women) were included. Predominant GERD symptoms were heartburn and regurgitation in 103/260 (40%). 70% received a maintenance treatment, which was proton pump inhibitor (PPI) in 55% of cases. An average number of 1.5 symptomatic relapses per patient/year of follow-up were observed. A progression to erosive gastro-esophageal reflux disease (ERD) was found in 58/193 (30.0%) of patients undergoing repeat endoscopy; 72% of these were Los Angeles grade A-B.


CONCLUSIONS
This study shows that progression to ERD occurs in about 5% of NERD cases per year, despite therapy. Only two factors consistently and independently influence progression: smoking and absence of PPI therapy.
Pace
Fabio
F
Division of Gastroenterology, Department of Clinical Sciences, L Sacco University Hospital, Milano, Italy. fabio.pace@unimi.it
Pallotta
Stefano
S
Manes
Gianpiero
G
de Leone
Annalisa
A
Zentilin
Patrizia
P
Russo
Luigi
L
Savarino
Vincenzo
V
Neri
Matteo
M
Grossi
Enzo
E
Cuomo
Rosario
R
D000328:Adult; D018450:Disease Progression; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors