Brief Article
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World J Gastroenterol. Apr 28, 2013; 19(16): 2514-2520
Published online Apr 28, 2013. doi: 10.3748/wjg.v19.i16.2514
Gastroesophageal reflux disease after diagnostic endoscopy in the clinical setting
Nora B Zschau, Jane M Andrews, Richard H Holloway, Mark N Schoeman, Kylie Lange, William CE Tam, Gerald J Holtmann
Nora B Zschau, Jane M Andrews, Richard H Holloway, Mark N Schoeman, William CE Tam, Gerald J Holtmann, Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
William CE Tam, Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Adelaide, SA 5112, Australia
Jane M Andrews, Richard H Holloway, Kylie Lange, Gerald J Holtmann, Faculty of Health Sciences, University of Adelaide, Adelaide, SA 5005, Australia
Gerald J Holtmann, Department of Gastroenterology and Hepatology, University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, Woolloongabba, QLD 4102, Australia
Author contributions: Zschau NB and Holtmann GJ worked at study concept and design; Holloway RH contributed to the study design; Zschau NB, Schoeman MN and Tam WCE acquired data; Zschau NB, Andrews JM, Holloway RH, Schoeman MN, Lange K, Tam WCE and Holtmann GJ analysed and interpreted data; Zschau NB and Holloway RH wrote manuscript; Zschau NB, Andrews JM, Schoeman MN, Lange K, Tam WCE and Holtmann GJ revised manuscript; Holtmann GJ obtained funding.
Supported by An Unrestricted Grant from Nycomed
Correspondence to: Gerald J Holtmann, MD, PhD, MBA, FRACP, FRCP, Professor, Department of Gastroenterology and Hepatology, University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, Ipswich Road, Woolloongabba, QLD 4102, Australia. g.holtmann@uq.edu.au
Telephone: +61-424-956000 Fax: +61-7-31762701
Received: November 21, 2012
Revised: January 10, 2013
Accepted: January 23, 2013
Published online: April 28, 2013
Processing time: 162 Days and 1.4 Hours
Abstract

AIM: To investigate the outcome of patients with symptoms of gastroesophageal reflux disease (GERD) referred for endoscopy at 2 and 6 mo post endoscopy.

METHODS: Consecutive patients referred for upper endoscopy for assessment of GERD symptoms at two large metropolitan hospitals were invited to participate in a 6-mo non-interventional (observational) study. The two institutions are situated in geographically and socially disparate areas. Data collection was by self-completion of questionnaires including the patient assessment of upper gastrointestinal disorders symptoms severity and from hospital records. Endoscopic finding using the Los-Angeles classification, symptom severity and it’s clinically relevant improvement as change of at least 25%, therapy and socio-demographic factors were assessed.

RESULTS: Baseline data were available for 266 patients and 2-mo and 6-mo follow-up data for 128 and 108 patients respectively. At baseline, 128 patients had erosive and 138 non-erosive reflux disease. Allmost all patient had proton pump inhibitor (PPI) therapy in the past. Overall, patients with non-erosive GERD at the index endoscopy had significantly more severe symptoms as compared to patients with erosive or even complicated GERD while there was no difference with regard to medication. After 2 and 6 mo there was a small, but statistically significant improvement in symptom severity (7.02 ± 5.5 vs 5.9 ± 5.4 and 5.5 ± 5.4 respectively); however, the majority of patients continued to have symptoms (i.e., after 6 mo 81% with GERD symptoms). Advantaged socioeconomic status as well as being unemployed was associated with greater improvement.

CONCLUSION: The majority of GORD patients receive PPI therapy before being referred for endoscopy even though many have symptoms that do not sufficiently respond to PPI therapy.

Keywords: Gastroesophageal reflux disease; Epidemiology; Proton pump inhibitor; Acid suppressive therapy; Endoscopy; Barrett’s esophagus; Functional gastrointestinal disorders