The natural history of gastro-esophageal reflux disease: a comprehensive review

Abstract

Gastroesophageal reflux disease (GERD) is a common disorder of the upper gastrointestinal tract which is typically characterized by heartburn and acid regurgitation. These symptoms are widespread in the community and range from 2.5% to more than 25%. Economic analyses showed an increase in direct and indirect costs related to the diagnosis, treatment and surveillance of GERD and its complications. The aim of this review is to provide current information regarding the natural history of GERD, taking into account the evolution of its definition and the worldwide gradual change of its epidemiology. Present knowledge shows that there are two main forms of GERD, that is erosive reflux disease (ERD) and non-erosive reflux disease (NERD) and the latter comprises the majority of patients (up to 70%). The major complication of GERD is the development of Barrett esophagus, which is considered as a pre-cancerous lesion. Although data from medical literature on the natural history of this disease are limited and mainly retrospective, they seem to indicate that both NERD and mild esophagitis tend to remain as such with time and the progression from NERD to ERD, from mild to severe ERD and from ERD to Barrett's esophagus may occur in a small proportion of patients, ranging from 0 to 30%, 10 to 22% and 1 to 13% of cases, respectively. It is necessary to stress that these data are strongly influenced by the use of powerful antisecretory drugs (PPIs). Further studies are needed to better elucidate this matter and overcome the present limitations represented by the lack of large prospective longitudinal investigations, absence of homogeneous definitions of the various forms of GERD, influence of different treatments, clear exclusion of patients with functional disorders of the esophagus.

Esophageal physiologic profiles within erosive esophagitis in China: Predominantly low‐grade esophagitis with low reflux burden

“…The Lyon Consensus regarded LA grade A&B EE as the inconclusive evidence for GERD diagnosis for the reason that LA grade A&B EE can be encountered in 5.0%‐7.5% of asymptomatic controls, and only 1%‐6% of LA grade A&B EE could progress to LA grade C&D EE . A previous study performed among 2580 individuals referred for upper endoscopy in our hospital found that the detection rate of EE was only 4.30%, which was much lower than that of 11.8%‐15.5% in western countries .…”

Ambulatory reflux monitoring for diagnosis of gastro‐esophageal reflux disease: Update of the Porto consensus and recommendations from an international consensus group

“…Indeed grade B esophagitis might be encountered in asymptomatic controls. Further progression from grade A/B esophagitis to grade C/D and Barrett's esophagus is observed in 1% to 6% and 1% to 12%, respectively, while it may regress to normal endoscopy in 20% to 60% . Thus, grade B esophagitis is not sufficient to unambivalently proof that a subject symptoms are caused by GERD.…”

Detection of laryngeal carcinoma in the U.S. elderly population with gastroesophageal reflux disease

“…7 In that study, the association between GERD and malignancy of the larynx was greater than any other subsite of the upper aerodigestive tract. This has clinical importance as GERD affects up to 30% of the elderly population 35 and is more commonly encountered in elderly or obese patients. 36 GERD is a risk factor for the development of Barrett's esophagus, a premalignant condition of esophageal adenocarcinoma.…”