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©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Dec 7, 2009; 15(45): 5700-5705
Published online Dec 7, 2009. doi: 10.3748/wjg.15.5700
Outcome of nonerosive gastro-esophageal reflux disease patients with pathological acid exposure
Fabio Pace, Stefano Pallotta, Gianpiero Manes, Annalisa de Leone, Patrizia Zentilin, Luigi Russo, Vincenzo Savarino, Matteo Neri, Enzo Grossi, Rosario Cuomo
Fabio Pace, Stefano Pallotta, Gianpiero Manes, Annalisa de Leone, Division of Gastroenterology, Department of Clinical Sciences, “L. Sacco” University Hospital, Via G. B. Grassi, 74-20157, Milano, Italy
Patrizia Zentilin, Vincenzo Savarino, Gastroenterology Unit, D.I.M.I, University of Genova, Viale Benedetto XV 6, 16132, Genova, Italy
Luigi Russo, Rosario Cuomo, Gastroenterology Unit, Dip. Med. Clin e Sper., AOU Federico II, Via S. Pansini 5, 80131, Napoli, Italy
Matteo Neri, Department of Medicine and Aging Sciences and Ce.S.I, “G. D’Annunzio” University & Foundation, Via dei Vestini 31, 66013, Chieti, Italy
Enzo Grossi, Department of Medical, Bracco Imaging SpA, Via XXV Aprile, 4, 20097 San Donato Milanese, Milano, Italy
Author contributions: Pace F designed the research; Savarino V, Neri M and Cuomo R contributed equally to this work; Pallotta S, Zentilin P and Russo L collected the data and performed the research; Manes G analyzed the data; Grossi E contributed to statistical analysis; Pace F and de Leone A wrote the paper.
Correspondence to: Dr. Fabio Pace, MD, Division of Gastroenterology, Department of Clinical Sciences, “L. Sacco” University Hospital, Via G. B. Grassi, 74-20157 Milano, Italy. fabio.pace@unimi.it
Telephone: +39-2-39042943 Fax: +39-2-39042337
Received: September 8, 2009
Revised: October 17, 2009
Accepted: October 24, 2009
Published online: December 7, 2009
AIM: To assess the management and outcome of nonerosive gastro-esophageal reflux disease (NERD) patients who were identified retrospectively, after a 5-year follow-up.
METHODS: We included patients with gastro-esophageal reflux disease (GERD) symptoms who had a negative endoscopy result and pathological 24-h esophageal pH-monitoring while off therapy. We interviewed them after an average period of 5 years (range 3.5-7 years) by means of a structured questionnaire to assess presence of GERD symptoms, related therapy, updated endoscopic data and other features. We assessed predictors of esophagitis development by means of univariate and multivariate statistical analysis.
RESULTS: 260 patients (137 women) were included. Predominant GERD symptoms were heartburn and regurgitation in 103/260 (40%). 70% received a maintenance treatment, which was proton pump inhibitor (PPI) in 55% of cases. An average number of 1.5 symptomatic relapses per patient/year of follow-up were observed. A progression to erosive gastro-esophageal reflux disease (ERD) was found in 58/193 (30.0%) of patients undergoing repeat endoscopy; 72% of these were Los Angeles grade A-B.
CONCLUSION: This study shows that progression to ERD occurs in about 5% of NERD cases per year, despite therapy. Only two factors consistently and independently influence progression: smoking and absence of PPI therapy.
