Long-term gastric acid suppression has been suggested as a means to prevent complications of reflux esophagitis.
Dr Stephen Sontag and colleagues evaluated a 20-year follow-up of 2306 patients with at least 2 endoscopic examinations.
The patients were taking no antisecretory medication before baseline endoscopy.
The long-term treatment of the patients was determined by reflux symptoms.
Endoscopy and biopsy in the Hines Veterans Affairs Hospital endoscopy clinic by 3 endoscopists from 1979 to 1988.
Antireflux treatment was symptom-driven, and endoscopies were repeated mostly for symptomatic recurrence due to cessation of therapy.
The researcher team reported that 4633 patients underwent endoscopy for reflux symptoms.
|The esophageal mucosa in 67% of patients remained unchanged over 8 years|
|Journal of Clinical Gastroenterology|
Of these, 2306 had at least 1 follow-up endoscopy and biopsy.
The team found that over a mean follow-up period of 8 years, the esophageal mucosa of 67% of patients remained unchanged.
The team also noted that 21% of patients improved, and 11% worsened.
Esophageal stricture requiring dilation developed from a normal baseline mucosa in 1 of 1313 patients, and from an erosive baseline mucosa in 18 of 957 patients.
The researchers observed that the overall incidence of stricture in patients with gastroesophageal reflux disease (GERD) was less than 1 in 1000 per year.
Nonsteroidal anti-inflammatory drug consumption was associated with less mucosal improvement.
The team found that the use of histamine-2 receptor antagonists, and proton pump inhibitors was associated with mucosal improvement.
Cohn's kappa was 42%, confirming the results that demonstrate stability of esophageal mucosal disease in the majority of patients.
Dr Sontag's team concluded, “Symptom-driven treatment of gastroesophageal reflux disease after a thorough endoscopic examination to exclude premalignant or malignant esophageal mucosal disease is practical and safe for the vast majority of patients with uncomplicated gastroesophageal reflux symptoms.”