MANAGEMENT OF PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE - A LONG-TERM, FOLLOW-UP-STUDY

Although the effect of short-term treatment on gastroesophageal reflux disease (GERD) has been studied, there is little information concerni ng the long-term outcome of this disease. The aim of the present study was to follow up a patient population with GERD to identify variables that could be used to predict the disease course. From 1989 to 1991, we assessed 349 patients with GERD. Barium roentgenogram, esophagoscop y with biopsy, and ambulatory esophageal 24-hour pH monitoring were pe rformed in each patient at baseline. One hundred eight outpatients,vit h typical symptoms of gastroesophageal reflux and pathologic findings on 24-hour pH monitoring were included in the study. After diagnosis o f GERD, patients mere instructed to adhere to a specific diet and life style regimen. Subsequently, on the basis of symptoms, the severity of esophagitis, and the degree of acid reflux, patients were assigned to a pharmacologic treatment using antacids, cisapride, ranitidine, and omeprazole, alone or in combination. Patients were followed up after 4 0 days and then yearly for 7 years using endoscopy and clinical examin ation. During the 7-year follow-up, 14 patients (13%) dropped out (2 o f the 14 died of causes not related to GERD) and 6 patients (6%) under went surgery to correct the reflux. Twenty-three patients (21%) discon tinued pharmacologic treatment because of a stable improvement of thei r symptoms, whereas 65 (60%) continued the drug therapy. The present s tudy demonstrated that reflux symptoms can improve and even disappear after treatment, but only in a small percentage of patients with GERD. The majority of patients must continue drug therapy. Moreover, a comp lete evaluation of patients at entry showed the following factors to b e highly predictive of unfavorable disease progression: the presence a nd grade of esophagitis, a high grade of gastroesophageal reflux durin g 24-hour pH monitoring and while in the supine position, and the pres ence of hiatal hernia.