Systematic review: persistence and severity in gastro-oesophageal reflux disease

Abstract

Background: Management strategies for gastro-oesophageal reflux disease (GERD) are often inconsistent with the proposition that it is a persistent or chronic disease.

Aim: To determine the persistence of reflux symptoms and complications associated with GERD.

Methods: Systematic searches of Medline and EMBASE.

Results: In longitudinal studies, 65% (95% CI 54-75%) of patients with complicated GERD and 70% (95% CI 57-83%) of patients with 'defined' GERD had persistent disease at follow-up, whereas 34% (95% CI 27-40%) with infrequent or mild reflux symptoms at baseline had persistent symptoms. Clinical trials of maintenance treatment for at least 6 months after healing of oesophagitis reported mean relapse rates of 75% (95% CI 68-82%) in patients taking placebo and 28% (95% CI 21-35%) in those taking proton pump inhibitors. Retrospective studies reported that 34-41% of individuals with GERD recalled experiencing their symptoms for >10 years. The prevalence of GERD is high (10-20%), whereas the incidence is low (4.5-19.6 cases per 1000 person-years), suggesting that GERD is likely to persist for at least 18 years.

Conclusions: Individuals with GERD have persistent reflux symptoms that merit management as a chronic disease; infrequent reflux symptoms are less likely to be chronic and may respond to different management strategies.