[Diagnosis and clinical course in gastroesophageal reflux]

We have previously shown, that longterm pH-monitoring is of high clinical value for the diagnosis of gastro-oesophageal reflux disease. With this method, we were able to define a sample of 166 patients with proven reflux disease. All patients had typical reflux symptoms (heartburn and/or acid regurgitation) and pathologic pH-monitoring (diurnal reflux time > 8.2% and/or nocturnal reflux time > 3.0%). They were followed up by questionnaire and interview for a mean of 41 (range: 7-86) months after diagnosis of reflux disease.

Ten patients died of causes unrelated to reflux. In 117 (75%) of the remaining 156 patients data on the further course of the disease could be obtained. Twelve patients underwent anti-reflux surgery. Forty-one (39%) of the remaining 105 patients stopped taking medication, 13 of whom had no longer any symptoms. Sixty-four (61%) patients continued to use medication (40 as needed, 24 regularly). In comparison with baseline, symptoms were either unchanged or worse without medication in 71 patients, and better in 21. Patients with persisting symptoms during follow-up had significantly more nocturnal reflux initially (p < 0.05). The parameters oesophageal erosions at initial endoscopy, duration of reflux, age, sex, and smoking habits had no predictive value for the course of the disease. In conclusion, reflux symptoms appear to clear up spontaneously only in a minority of patients. More than half of all patients continue to use medication either as needed or regularly, with quite good results. Severe nocturnal reflux is an unfavorable prognostic factor.