Epidemiology and Natural History of Reflux Esophagitis

Abstract

Studies describing the natural history of erosive reflux esophagitis in patients presenting with or without symptoms of gastroesophageal reflux are exceedingly rare. This study followed a first group of 759 patients receiving intermittent courses of medical therapy for initial Savary grades 1 to 3 reflux esophagitis (median follow-up period of 4.5 years). In 23% of cases, reflux esophagitis evolved as a recurrent progressive form of the disease, which may potentially cause attendant complications such as ulcer, stenosis, or short esophagus; to avoid unnecessary long-term medical treatment, surgery should be considered in these cases if the patient is fit for surgery. In the remaining 77% of cases, reflux esophagitis evolved as a benign form of the disease, either as an isolated episode of reflux esophagitis or as a recurrent but nonprogressive form of the disease. Another group of 1,022 patients presenting with initial Savary grades 1 to 4 reflux esophagitis (median follow-up period of 3 years) was studied to detect the appearance of columnar epithelium during the healing process. In 18% of all cases, follow-up endoscopies detected islands, tongues, or circumferential forms of columnar epithelium as patterns of healing of the initial erosions; these patients should undergo endoscopic surveillance for the detection of dysplasias, especially if a specialized type of epithelium is present on biopsy specimens.