title: Outcome of nonerosive gastro-esophageal reflux disease patients with pathological acid exposure.
abstract: 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.
authors: Division of Gastroenterology, Department of Clinical Sciences, L Sacco University Hospital, Milano, Italy. fabio.pace@unimi.it
authors: Fabio
authors: F
authors: Pace
authors: Stefano
authors: S
authors: Pallotta
authors: Gianpiero
authors: G
authors: Manes
authors: Annalisa
authors: A
authors: de Leone
authors: Patrizia
authors: P
authors: Zentilin
authors: Luigi
authors: L
authors: Russo
authors: Vincenzo
authors: V
authors: Savarino
authors: Matteo
authors: M
authors: Neri
authors: Enzo
authors: E
authors: Grossi
authors: Rosario
authors: R
authors: Cuomo
mesh_terms: 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
chemical_list: D054328:Proton Pump Inhibitors