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

SummaryBackground 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.

Systematic review: persistence and severity in gastro‐oesophageal reflux disease Journal Articles