Evolution of gastro-oesophageal reflux disease over 5 years under routine medical care - the ProGERD study

Aliment Pharmacol Ther 2012; 35: 154–164 Summary Background The evolution of gastro‐oesophageal reflux disease (GERD) under current management options remains uncertain. Aim To examine whether, depending on the initial presentation, non‐erosive (NERD) and erosive reflux disease (ERD) without Barrett’s oesophagus will progress to more severe disease under current routine care following the resolution of the initial condition. Methods Patients with the primary symptom of heartburn were included at baseline, and stratified into non‐erosive (NERD) and erosive reflux disease (ERD), LA grades A–D (Los Angeles classification). After a 2‐ to 8‐week course with esomeprazole therapy to achieve endoscopic healing in ERD and symptom relief in NERD, patients were treated routinely at the discretion of their physician. We report oesophagitis status and the presence of endoscopic and confirmed Barrett’s oesophagus after 5 years. Results A total of 6215 patients were enrolled in the study of whom 2721 patients completed the 5‐year follow‐up. Progression, regression and stability of GERD severity were followed from baseline to 5 years. Only a few patients with NERD and mild/moderate ERD progressed to severe forms of ERD and even Barrett’s oesophagus. Most patients remained stable or showed improvement in their oesophagitis; 5.9% of the NERD patients, 12.1% of LA grade A/B patients and 19.7% of LA grade C/D patients in whom no Barrett’s oesophagus was recorded at baseline progressed to endoscopic or confirmed Barrett’s oesophagus at 5 years. Conclusion Most GERD patients remain stable or improve over a 5‐year observation period under current routine clinical care.