Severity of GERD and disease progression

Area of Science:

• Gastroenterology
• Digestive Diseases
• Esophageal Disorders

Background:

• Gastroesophageal reflux disease (GERD) pathophysiology is multifactorial, with controversial data on disease progression.
• Factors influencing GERD severity and progression require further investigation.
• Proton pump inhibitor (PPI) therapy in patients with persistent GERD symptoms necessitates analysis of disease characteristics.

Purpose of the Study:

• To analyze a large patient cohort with persistent GERD symptoms despite PPI therapy.
• To identify components characterizing GERD disease severity and progression.
• To explore the temporal relationship between GERD history and key disease markers.

Main Methods:

• Retrospective analysis of 972 patients with persistent GERD symptoms under PPI therapy.
• Data collection included physical status, esophageal acid exposure (EAE), esophagitis severity, anatomical changes, and esophageal function.
• Statistical analysis involved survival curves, Log-rank tests, COX-regression, and path analysis (structural equation modeling).

Main Results:

• A longer GERD disease history was significantly associated with lower esophageal sphincter (LES) incompetence and higher EAE.
• Patients with LES incompetence had a longer mean duration of symptoms (9 years) compared to those with intact LES (6 years).
• Path analysis revealed a significant causal sequence: disease history influenced LES incompetence and hiatal hernia, which in turn affected pH score.

Conclusions:

• Long-standing GERD is linked to LES incompetence, hiatal hernia, and increased EAE.
• Functional deterioration of the LES and anatomical changes at the esophagogastric junction are associated with prolonged GERD.
• Path modeling suggests a predictable causal sequence of GERD progression over time.