Disease progression in non-erosive reflux disease (NERD): impact of initial esophageal acid exposure.
We investigated the 5-year clinical course in a cohort of patients with typical reflux symptoms and negative endoscopy. Prospective follow-up was conducted in patients with non-erosive reflux disease (NERD) for at least 5 years after initial evaluation with esophageal pH monitoring and upper gastrointestinal endoscopy. Within the last year of follow-up, reflux symptoms occurred in 27 of the 30 patients (90%). Twenty-five of twenty-seven symptomatic patients (93%) were on acid suppression therapy. The majority of our patients (70%) remained unchanged regarding their endoscopic status over 5 years. Progression to erosive esophagitis occurred in four patients with Los Angeles (LA) A (13%), three patients with LA B (10%), and two patients with LA C (7%). The presence of pathological acid exposure did not alter the presence of reflux symptoms over 5 years. Disease progression to erosive esophagitis occurred more frequently in patients with pathological acid exposure than those without pathological acid exposure (P= 0.025). Most NERD patients have symptoms and require acid suppression therapy 5 years after their initial diagnosis. Initial pathological acid exposure does not influence the use of acid suppression; however, it does influence the progression of NERD within 5 years of follow-up.
Chen
C L
CL
Department of Medicine, Buddhist Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan. harry.clchen@msa.hinet.net
Liu
T T
TT
Yi
C H
CH
D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D017050:Episode of Care; D050782:Esophageal pH Monitoring; D004942:Esophagitis, Peptic / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013624:Taiwan; D013995:Time
D000897:Anti-Ulcer Agents