The effect of metabolic risk factors on the natural course of gastro-esophageal reflux disease (GERD), which remains elusive, was quantified.
Dr Lee and colleagues from Taiwan assessed 3669 subjects undergoing repeated upper endoscopy.
Data were analyzed using a 3-state Markov model to estimate transition rates, according to the Los Angeles classification, regarding the natural course of the disease.
Individual risk scores together with the kinetic curve was derived by identifying significant factors responsible for the net force between progression and regression.
|The annual transition rate from non-erosive to class A-B disease was 0.2 per person year|
The researchers found that during 3 consecutive study periods, 12%, 15% and 18% of subjects, respectively, progressed from non-erosive to erosive disease.
However, 43%, 37% and 35%, regressed to the non-erosive stage during 3 consecutive study periods, respectively.
The annual transition rate from non-erosive to class A-B disease was 0.2 per person year, and from class A-B to C–D was 0.08 per person year.
The team found the regression rate from class A–B to non-erosive disease was 0.48 per person year.
Class C–D, however, appeared to be an absorbing state when not properly treated.
The research team found that being male, smoking or having metabolic syndrome independently increased the likelihood of progressing from a non-erosive to an erosive stage of disease and/or lowered the likelihood of disease regression.
The short-term use of acid suppressants raised the likelihood of regression from erosive to non-erosive disease.
Dr Lee’s team concluded, “Intraesophageal damage is a dynamic and migratory process in which the metabolic syndrome is associated with accelerated progression to or attenuated regression from erosive states.”
“These findings have important implications for the design of effective prevention and screening strategies.”