DISEASE PROGRESSION IN GASTROESOPHAGEAL REFLUX DISEASE AS DETERMINED BY REPEAT ESOPHAGEAL PH MONITORING AND ENDOSCOPY 3 TO 4.5 YEARS AFTER DIAGNOSIS

Objectives: Reflux oesophagitis may progress to complications such as Barrett's mucosa and stricture formation. However, few studies have as sessed long-term disease progression in oesophagitis patients and fewe r still have considered disease progression in the significant proport ion of gastro-oesophageal reflux disease (GORD) patients who do not ha ve oesophagitis at diagnosis. The aim of this study was to reassess GO RD patients 3 to 4 years after initial diagnosis and determine whether or not disease progression had occurred. Methods: Prospective follow- up of 101 GORD patients at least 32 months after initial assessment wi th oesophageal pH monitoring and upper gastrointestinal endoscopy. Pat ients were invited to complete a symptomatic questionnaire and undergo repeat investigation with the same techniques. Results: Seventy-seven (76%) patients responded (mean follow-up period 39 months, range 32-5 4 months) of whom 28 initially had oesophagitis (group A), 17 had norm al endoscopy but abnormal pH monitoring (group B) and 32 had normal in vestigations but typical reflux symptoms (group C). At the time of fol low-up, 57 (74%) patients either had frequent heartburn or were taking daily acid suppression therapy. Fifty-two (68%) responders had at lea st one repeat investigation: 44 (57%) had repeat pH monitoring; 43 (56 %) had repeat endoscopy. Three (11% of the 28 responders) group A pati ents had developed Barrett's mucosa, 4 (24% of responders) group B pat ients had developed oesophagitis and 10 (31% of responders) group C pa tients had developed abnormal pH monitoring (4), oesophagitis (4) or b oth (2). Conclusion: Three-quarters of GORD patients still have troubl esome symptoms at least 3 years after diagnosis and a significant prop ortion show endoscopic progression of the condition's severity.