3-YEAR TO 4.5-YEAR PROSPECTIVE-STUDY OF PROGNOSTIC INDICATORS IN GASTRO-OESOPHAGEAL REFLUX DISEASE

Background: Data on the long-term natural history of gastro-oesophagea l reflux disease (GORD) are sparse. This prospective study was designe d to determine the clinical outcome on the basis of therapeutic requir ements 3 to 4.5 years after initial diagnosis of CORD and to identify specific prognostic indicators of a poor outcome. Methods: One hundred and one GORD patients were followed up by symptomatic questionnaire 3 to 4.5 years after diagnosis and offered repeat investigation with en doscopy and oesophageal pH monitoring if symptoms persisted. Results: Seventy-seven (76%) patients responded (mean follow-up period, 39 mont hs; range, 32-54 months); of these, 28 had grade-II or -III oesophagit is at initial endoscopy, 17 had normal endoscopy but abnormal pH monit oring, and 32 had normal investigations but frequent heartburn. At fol low-up 32 (42%) were taking acid suppression therapy, and a further 15 patients started acid suppression therapy after repeat investigation indicated a need to do so, giving a total of 47 (61%) patients receivi ng acid suppression. The following factors predicted a need for acid s uppression at follow-up: oesophagitis on initial endoscopy (P = 0.009) , abnormal pH monitoring (P = 0.0005), increased age (P < 0.0005), and increased body mass index (BMI) (P = 0.001). Gender, smoking status, alcohol intake, and lower oesophageal sphincter pressure had no progno stic value. Regression analysis confirmed that age (P = 0.0007), BMI ( P = 0.04), and endoscopy result (P = 0.04) all independently affected outcome. Conclusions: Most GORD patients still require acid suppressio n therapy 3 to 4.5 years after initial diagnosis. Age, BMI, and presen ce of oesophagitis at initial endoscopy all independently predict thos e who will require long-term acid suppression therapy.