Predictive factors of the long term outcome in gastro-oesophageal reflux disease: six year follow up of 107 patients.

Abstract

There is little information concerning the long term outcome of patients with gastrooesophageal reflux disease (GORD). Thus 109 patients with reflux symptoms (33 with erosive oesophagitis) with a diagnosis of GORD after clinical evaluation and oesophageal testing were studied. AU patients were treated with a stepwise approach: (a) lifestyle changes were suggested aimed at reducing reflux and antacids and the prokinetic agent domperidone were prescribed; (b) H2 blockers were added after two months when symptoms persisted; (c) anti-reflux surgery was indicated when there was no response to (b). Treatment was adjusted to maintain clinical remission during follow up. Long term treatment need was defined as minor when conservative measures sufficed for proper control, and as major if daily H2 blockers or surgery were required. The results showed that one third of the patients each had initial therapeutic need (a), (b), and (c). Of 103 patients available for follow up at three years and 89 at six years, respective therapeutic needs were minor in 52% and 55% and major in 48% and 45%. Eighty per cent of patients in (a), 67% in (b), and 17% in (c) required only conservative measures at six years. A decreasing lower oesophageal sphincter pressure (p<0-001), radiological reflux (p=0028), and erosive oesophagitis (p=0-031), but not initial clinical scores, were independent predictors of major therapeutic need as shown by multivariate analysis. The long term outcome of GORD is better than previously perceived.

Prognostic factors for relapse of reflux oesophagitis and symptoms during 12 months of therapy with lansoprazole

“…2 Kuster and co-workers found that a low LES resting tone predicted a need for long-term therapy with H 2 -receptor antagonists or anti-re¯ux surgery. 8 In the present study, however, neither severity of gastrooesophageal re¯ux nor LES tone seemed to predict time to relapse. Gastric acidity was a signi®cant predictive factor, possibly due to duodenogastric re¯ux, which is more common in patients with more severe re¯ux disease.…”

“…6,7 Lower oesophageal sphincter (LES) tone has been considered an important determinant for competence of the cardia and in predicting long-term outcome. 2,8 Gastric Helicobacter pylori infection is probably not a causal factor in re¯ux oesophagitis, but is thought to affect response to acidsuppressive therapy with omeprazole. 9,10 We set out to consider the predictive value of these data in assessing time to endoscopic and/or symptomatic relapse in patients on maintenance treatment with the proton pump inhibitor lansoprazole.…”

Prognostic factors influencing relapse of oesophagitis during maintenance therapy with antisecretory drugs: a meta‐analysis of long‐term omeprazole trials

“…13±18 However, similar studies of the risk of relapse after cessation of treatment, 14,17 or during maintenance treatment, have shown con¯icting results regarding the importance of the severity of oesophagitis as a predictor for relapse. 28,29,40,41 This was therefore a major focus of our analysis. The sensitivity of this evaluation was affected by the use of two systems for grading of the severity of re¯ux oesophagitis within the ®ve studies evaluated.…”

Maintenance therapy with cisapride after healing of erosive oesophagitis: a double‐blind placebo‐controlled trial

“…In particular, lower oesophageal sphincter pressure and grade of oesophagitis, which have been identi®ed by others as useful indicators of outcome, did not have any prognostic value. 5,10,14,25 It could be argued that this study has not demonstrated whether or not cisapride prevents endoscopic relapse. However, if a patient's symptoms have relapsed to the extent that the patient requests further therapeutic intervention (as in this study), then in clinical practice this is a failure of therapy regardless of whether or not endoscopy shows a return of oesophageal erosions.…”