Introduction Gastro-oesophageal reflux disease (GORD) is a common condition with a prevalence of about 20% in Western countries.1 In some patients GORD symptoms are associated with oesophageal mucosal injury, yet in others there is no macroscopic evidence of erosive disease. We sought to assess the natural history of patients with GORD symptoms with respect to the persistence or emergence of erosive disease over time, as well as the development of complications, including oesophageal strictures, Barrett's epithelium (BE) and oesophageal cancer.
Methods We analysed a database of over 50 000 oesophagogastroduodenoscopies (OGDs) performed at our unit between 1985 and 2006. From this database, we identified all patients undergoing OGD for GORD symptoms, who had subsequently undergone at least one further OGD at least 6 months after the index OGD. At the index OGD patients were categorised as having erosive oesophagitis (EE) or non-erosive reflux disease (NERD) based upon the presence or absence of mucosal injury. Changes or persistence of the index phenotype (EE or NERD) during follow-up OGDs were defined, as were the development of strictures, BE or oesophageal cancer.
Results We identified 394 patients undergoing at least two OGDs for GORD symptoms. EE was present at the index endoscopy in 38% of patients (50% male, mean age 54 years) and NERD in 62% (53% male, mean age 54 years). Mean follow-up time was 4.8 years for EE and 5.2 years in NERD patients. Results of follow-up OGDs are shown in Abstract 062.
Conclusion Patients with symptomatic GORD who undergo repeat OGD, even over extended time periods (mean follow-up 5 years) have a stable phenotype with respect to the persistence of EE or NERD, although NERD is significantly more likely to persist as a phenotype than EE. Patients with EE are significantly more prone to GORD complications.
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