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

Malfertheiner, Peter; Nocon, Marc; Vieth, Michael; Stolte, Manfred; Jaspersen, D; Koelz, H. R.; Labenz, Joachim; Leodolter, Andreas; Lind, Tore; Richter, Kai; Willich, Stefan N.

doi:10.1111/j.1365-2036.2011.04901.x

Cited by 142 publications

(64 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

Section: Mortality In Patients Hospitalised With Crohn's Diseasesupporting

confidence: 68%

“…2,3 It is notable that their finding a higher 3-year mortality in patients admitted as an emergency and patients treated medically, rather than surgically, is consistent with studies of admissions for CD in the late 1990's, particularly with regard to the elderly. 4,5 Furthermore, their finding that surgery delayed >7 days from admission was associated with increased 3-year mortality, might support a case for earlier surgical intervention.…”

Section: Mortality In Patients Hospitalised With Crohn's Diseasesupporting

confidence: 68%

“…Patients with BO at baseline have been excluded from the analysis in this follow-up study 2 as their evolution will be addressed in a separate report. Concerning progression of BO during follow-up, in spite of the regular use of PPI, may result from inadequate dosing of PPI in the specific subset of patients.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Evolution of GERD over 5 years: author’s reply

Malfertheiner¹

2012

Aliment Pharmacol Ther

Self Cite

View full text Add to dashboard Cite

We appreciate the highly pertinent questions and comments by Drs Aro and Ronkainen 1 concerning our observations made on disease evolution in patients with gastrooesophageal reflux disease under routine care, over a follow-up period of 5 years.As to the number of endoscopists from 1253 participating centres who enrolled a total of 6215 patients with erosive reflux disease (ERD) and non-erosive reflux disease (NERD), we cannot provide the exact figure. However, the majority of participating centres were each invited to include four consecutive patients with GERD, and most of these were out-patient services led by one individual specialist performing the endoscopy.All participating endoscopists were educated in the adoption of the Los Angeles classification for the description of oesophageal erosions as well as in the accurate endoscopic description of any detectable columnar lined epithelium (Barrett's oesophagus). This was the best we could do, considering the pragmatic nature of the study that intended to follow-up patients with ERD and NERD under routine medical care. Inter-observer validation was impossible to do, but the standard of education provided and training in endoscopy is high in our country.Concerning the healing rate of 74% of patients with Barrett's oesophagus (BO) on regular PPI medication, as pointed out by Dr Aro and Dr Ronkainen, intended healing of erosions, if they were present, or complete symptom relief in patients who had no erosions. We have indicated with an asterisk in table 1 of the manuscript 2 that healing referred to erosions in the group with ERD and complete symptom relief in the group with NERD in the initial healing phase on PPI, 3 and this does also apply to the subset of 240 patients with additional BO at baseline, but does not imply regression of BO. Thank you, for allowing us to make this clarification.Patients were also allowed to be included if they were found to have BO (either suspected endoscopically or confirmed by histology) at the index endoscopy, and they were assigned to one of the two categories ERD or NERD. Patients with BO at baseline have been excluded from the analysis in this follow-up study 2 as their evolution will be addressed in a separate report. Concerning progression of BO during follow-up, in spite of the regular use of PPI, may result from inadequate dosing of PPI in the specific subset of patients. Beyond this hypothesis a definitive explanation cannot be given due to the observational nature of our study.The definition of BO in the follow-up cohort was either by endoscopy alone, if the detection of columnar lined epithelium was not corroborated by histology, or was 'confirmed' if combined with positive histology. According to the proposal of the Montreal classification of gastro-oesophageal reflux disease, we considered the histology to be positive for BO if the columnar lined epithelium contained either specialized intestinal metaplasia (IM) or gastric metaplasia. 4 An important finding in this context was that in the newly developed BO segments ...

show abstract

Section: Mortality In Patients Hospitalised With Crohn's Diseasesupporting

confidence: 68%

Section: Mortality In Patients Hospitalised With Crohn's Diseasesupporting

confidence: 68%

See 1 more Smart Citation

Evolution of GERD over 5 years: author’s reply

Malfertheiner¹

2012

Aliment Pharmacol Ther

Self Cite

View full text Add to dashboard Cite

show abstract

“…Despite medical therapy, in some patients disease may progress and lead to serious complications, such as volume regurgitation with aspiration and Barrett's metaplasia, a precursor to adenocarcinoma. The recently updated results of the ProGERD study, a large European open cohort multicenter study, showed that 9.7% of patients with GERD under routine medical care progress to Barrett's esophagus at 5 years of follow up [Malfertheiner et al 2012]. Potential risks associated with PPIs include B12 vitamin deficiency, Clostridium difficile infection, community-acquired pneumonia, hip fractures, and osteoporosis [Katz et al 2012].…”

Section: Comparison Of Current Therapeutic Options For Gastroesophagementioning

confidence: 99%

LINX^® Reflux Management System in chronic gastroesophageal reflux: a novel effective technology for restoring the natural barrier to reflux

Bonavina

Saino

Lipham

et al. 2013

Therap Adv Gastroenterol

View full text Add to dashboard Cite

Gastroesophageal reflux disease (GERD) results from incompetency of the lower esophageal sphincter that allows the contents of the stomach to reflux into the esophagus, the airways, and the mouth. The disease affects about 10% of the western population and has a profound negative impact on quality of life. The majority of patients are successfully treated with proton-pump inhibitors, but up to 40% have incomplete relief of symptoms even after dose adjustment. The laparoscopic Nissen fundoplication represents the surgical gold standard, but is largely underused because of the level of technical difficulty and the prevalence of side effects. These factors have contributed to the propensity of patients to continue with medical therapy despite inadequate symptom control and complications of the disease. As a consequence, a significant 'therapy gap' in the treatment of GERD remains evident in current clinical practice. The LINX ® Reflux Management System (Torax Medical, St. Paul, MN, USA) is designed to provide a permanent solution to GERD by augmenting the sphincter barrier with a standardized, reproducible laparoscopic procedure that does not alter gastric anatomy and is easily reversible. Two single-group trials confirmed that a magnetic device designed to augment the lower esophageal sphincter can be safely and effectively implanted using a standard laparoscopic approach. The device decreased esophageal acid exposure, improved reflux symptoms and quality of life, and allowed cessation of proton-pump inhibitors in the majority of patients.

show abstract

“…In previous studies, the progression rate from mild to severe is around 10% (6%-12.5%), although most studies were retrospective (31)(32)(33)(34)(35)(36)(37). In a prospective multicenter open cohort study, most GERD patients remained stable or improved over a 5-year observation period under current routine clinical care (38). Among those subjects, 10%-81% had unchanged symptoms and 19%-84% had reverted to normal or regressed.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and natural history of asymptomatic erosive esophagitis

Jung

Oh²,

Kang³

2014

Turk J Gastroenterol

View full text Add to dashboard Cite

show abstract

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

Abstract: SUMMARY BackgroundThe evolution of gastro-oesophageal reflux disease (GERD) under current management options remains uncertain.

Cited by 142 publications

References 35 publications

Evolution of GERD over 5 years: author’s reply

Evolution of GERD over 5 years: author’s reply

LINX^® Reflux Management System in chronic gastroesophageal reflux: a novel effective technology for restoring the natural barrier to reflux

Clinical characteristics and natural history of asymptomatic erosive esophagitis

Contact Info

Product

Resources

About

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

Abstract: SUMMARY BackgroundThe evolution of gastro-oesophageal reflux disease (GERD) under current management options remains uncertain.

Cited by 142 publications

References 35 publications

Evolution of GERD over 5 years: author’s reply

Evolution of GERD over 5 years: author’s reply

LINX® Reflux Management System in chronic gastroesophageal reflux: a novel effective technology for restoring the natural barrier to reflux

Clinical characteristics and natural history of asymptomatic erosive esophagitis

Contact Info

Product

Resources

About

LINX^® Reflux Management System in chronic gastroesophageal reflux: a novel effective technology for restoring the natural barrier to reflux