Disease Progression in Non-Erosive Reflux Disease (NERD): A Follow-up Report in an Asian Population

Abstract

Purpose: We investigated the 5-year clinical course in a cohort of patients with typical reflux symptoms and negative endoscopy. We also investigated whether baseline pathological esophageal acid exposure would influence the outcome of the clinical course. Methods: All patients had a 24-H pH evaluation at baseline. Prospective follow-up was conducted in this group of patients with non-erosive reflux disease (NERD) for at least 5 years after initial evaluation with esophageal pH monitoring and upper gastrointestinal endoscopy. Patients were asked to complete a symptomatic questionnaire. Results: Within the last year of follow-up, reflux symptoms occurred in twenty-seven of the thirty patients (90%) whenever active therapy was discontinued. Twenty-five of twenty-seven symptomatic patients (93%) were on acid suppression therapy. The majority of our patients (70%) remained unchanged in endoscopic status over 5 years. The progression to erosive esophagitis occurred in 4 patients with LA A (13%), 3 patients with LA B (10%), and 2 patients with LA C (7%). The presence of initial pathological acid exposure did not alter the presence of reflux symptoms or the use of acid suppression therapy over 5 years. Disease progression to erosive esophagitis occurred more frequently in patients with pathological acid exposure than those without pathological acid exposure (P=0.025). Conclusion: Most NERD patients still have symptoms and require acid suppression therapy 5 years after their initial diagnosis. Initial pathological acid exposure does not influence the use of acid suppression or symptom presentation; however, it does influence the progression of NERD within 5 years of follow-up.