title: The natural history of gastro-esophageal reflux disease: a comprehensive review.
abstract: Gastroesophageal reflux disease (GERD) is a common disorder of the upper gastrointestinal tract which is typically characterized by heartburn and acid regurgitation. These symptoms are widespread in the community and range from 2.5% to more than 25%. Economic analyses showed an increase in direct and indirect costs related to the diagnosis, treatment and surveillance of GERD and its complications. The aim of this review is to provide current information regarding the natural history of GERD, taking into account the evolution of its definition and the worldwide gradual change of its epidemiology. Present knowledge shows that there are two main forms of GERD, that is erosive reflux disease (ERD) and non-erosive reflux disease (NERD) and the latter comprises the majority of patients (up to 70%). The major complication of GERD is the development of Barrett esophagus, which is considered as a pre-cancerous lesion. Although data from medical literature on the natural history of this disease are limited and mainly retrospective, they seem to indicate that both NERD and mild esophagitis tend to remain as such with time and the progression from NERD to ERD, from mild to severe ERD and from ERD to Barrett's esophagus may occur in a small proportion of patients, ranging from 0 to 30%, 10 to 22% and 1 to 13% of cases, respectively. It is necessary to stress that these data are strongly influenced by the use of powerful antisecretory drugs (PPIs). Further studies are needed to better elucidate this matter and overcome the present limitations represented by the lack of large prospective longitudinal investigations, absence of homogeneous definitions of the various forms of GERD, influence of different treatments, clear exclusion of patients with functional disorders of the esophagus.
authors.affiliation: Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Savarino
authors.affiliation: Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
authors.forename: N
authors.initials: N
authors.lastname: de Bortoli
authors.affiliation: Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: C
authors.initials: C
authors.lastname: De Cassan
authors.affiliation: Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Della Coletta
authors.affiliation: Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Bartolo
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Furnari
authors.affiliation: Department of Surgical Medical Sciences and Integrated Diagnostic, University of Genoa, Genoa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ottonello
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Marabotto
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bodini
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Savarino
mesh_terms: D000328:Adult; D001471:Barrett Esophagus / Q000209:etiology; D018450:Disease Progression; D004941:Esophagitis / Q000209:etiology; D004947:Esophagus / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: GERD; NERD; endoscopy; erosive esophagitis; natural history