AUDIT OF REFLUX ESOPHAGITIS AT 4 YEARS

Background. Data on the natural history of reflux oesophagitis are few and conflicting: it is not clear whether in the long-term, patients s till require therapy for controlling symptoms and preventing endoscopi c relapse. Aims. To assess, in reflux oesophagitis patients followed u p for a median period of 4 years: a) clinical conditions throughout fo llow-up period (i.e., frequency of relapses, need and type of treatmen t, satisfaction with therapy; b) pre sent state, including quality of life, made of treatment, presence of residual symptoms or invalidity. Patients. A series of 288 consecutive outpatients, diagnosed as having reflux oesophagitis during the period 1986-1990, and followed up for at least 48 months. Methods. The study was carried out in two parts. T he first, retrospective, assessing the outcome throughout follow-up du ring which it was suggested that patients assume a maintenance therapy with H-2-receptor antagonists, proton pump inhibitors or other drugs for the first year and to continue only if desired. Patients returned for follow-up every six months, and endoscopy was repeated after the f irst year or in the case of symptom recurrence. In the second part, af ter a median follow-lip of 4 years, patients were submitted to a telep hone interview by means of a structured questionnaire, assessing type and severity of current symptoms (if any), type of current therapy, de gree of satisfaction with treatment and overall evaluation of quality of life. Results. Data are available from 132 patients (M/F = 85/47) o f whom 119 (90%) were still on treatment and 31% still presented sympt oms. During follow-up, 21% had more than 3 endoscopic relapses, 23% be tween 2 and 3, 28% one, and 28% zero, respectively and 79% were still adopting non-pharmacological measures (diet, posture, etc.). Only two (1.5%) had been submitted to surgery to control untractable symptoms/m ucosal lesions. Finally, 64% and 11%, respectively, considered the pre sent quality of life as good or excellent Conclusions. Contrary to man y reports, the prognosis of reflux oesophagitis is not favourable show ing a marked trend to chronicity; the disease leads to almost continuo us drug assumption for symptom control, and is associated with a high relapse risk after treatment withdrawal. Despite (or due to) these unf avourable features, patient compliance to both pharmacological and non -pharmacological therapy is excellent and, correspondingly, also the q uality of life is acceptable or improved.