title: Long-term complications to reflux disease in community practice. A 17-year cohort study of 4706 patients.
abstract: OBJECTIVE
  To examine the risk of developing strictures in patients with erosive and non-erosive gastroesophageal reflux disease in a community-based setting, since controlled trials indicate that the use of proton pump inhibitors renders the risk of strictures insignificant.
  
  
  METHODS
  A 17-year cohort study of 4706 patients referred to endoscopy due to upper GI symptoms, with a population comparison cohort of 47,060 individuals. All patients were followed and treated according to prevailing guidelines by their usual care provider. Main outcomes were relative risks (RR) and 95% confidence intervals (CI) for incident strictures and dilatations.
  
  
  RESULTS
  776 (16.5%) patients were diagnosed with erosive esophagitis, particularly men (61.2%). Over a period of 1-17 years (mean 10.5), 20 patients (2.6%) in the esophagitis group developed a peptic stricture, necessitating one or more dilatations in 16 patients (2.1%). Among the non-esophagitis patients, the incidences for both outcomes were 1.2%. Male gender doubled the risk of developing strictures, and alcohol abuse raised the risk four folds. Erosive patients had a risk of developing strictures eight times (95% CI: 5.0-13.0) higher than controls, whereas non-erosive patients' risk was 4.0 (95% CI: 2.8-5.7). The majority of strictures developed within the first 10 years after a diagnosis of esophagitis.
  
  
  CONCLUSIONS
  Patients with esophagitis had eight times higher risk of strictures than population controls and two times higher than dyspeptic patients without esophagitis. This indicates that long-term outcomes in general practice are poorer than in controlled trials, most likely due to a lack of compliance with medication.
authors.affiliation: Department of Surgical Gastroenterology L, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Frederik
authors.initials: F
authors.lastname: Hvid-Jensen
authors.forename: Lars
authors.initials: L
authors.lastname: Pedersen
authors.forename: Estrid Muff
authors.initials: EM
authors.lastname: Munk
authors.forename: Asbjørn Mohr
authors.initials: AM
authors.lastname: Drewes
authors.forename: Peter
authors.initials: P
authors.lastname: Funch-Jensen
mesh_terms: D000437:Alcoholism / Q000150:complications; D002404:Catheterization; D015331:Cohort Studies; D003153:Community Health Services; D003718:Denmark / Q000453:epidemiology; D004940:Esophageal Stenosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D004942:Esophagitis, Peptic / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012737:Sex Factors
chemical_list: D054328:Proton Pump Inhibitors