There is a controversy as to whether gastroesophageal reflux disease (GERD) exists as a spectrum of disease severity or as a categorial disease.
The categories are divided into 3 distinct groups, including nonerosive and erosive reflux disease, and Barrett's esophagus.
Dr Joachim Labenz and colleagues from Germany assessed progression or regression of GERD over 2 years in 3894 patients.
The patients were under routine clinical care in Germany, Austria, and Switzerland.
The investigative team recruited patients with predominant heartburn, with or without esophagitis.
The patients were classified according to endoscopic status at baseline.
The classification at baseline included nonerosive and erosive reflux disease-Los Angeles grade A/B or grade C/D, and Barrett's Esophagus.
|Barrett's risk in erosive and nonerosive reflux disease was about 1%|
|American Journal of Gastroenterology|
After an initial treatment with esomeprazole, the patients were followed, regardless of their response.
The investigators initiated medical therapy or endoscopy at the discretion of their primary care physician, in line with routine care.
At 2 years, the team performed endoscopy with biopsy according to the protocol.
After 2 years, 25% of patients who had nonerosive reflux disease at baseline progressed to Los-Angeles grade A/B, and less than 1% progressed to grade C/D.
The team noted that about 2% of patients who had Los Angeles grade A/B progressed to grade C/D, and 61% regressed to nonerosive reflux disease.
The investigators found that 42% with a Los Angeles C/D regressed to grade A/B, and 50% regressed to nonerosive reflux disease.
At 2 years, 22% of patients had been off medication for at least 3 months.
The team observed that those with erosive reflux disease and grade C/D were at greatest risk of developing Barrett's Esophagus, a risk of 6%.
For patients with erosive reflux disease and grade A/B, the risk was just over 1%.
The risk of developing Barrett's Esophagus in patients with nonerosive reflux disease, the risk was less than 1%.
Dr Labenz's team concludes, “GERD does not seem to be a categorial disease.”
“Progression and regression between grades was observed in this large cohort of patients under routine clinical care.”