Complaints in patients with reflux oesophagitis more than 10 years after the
diagnosis.
SMLA Loffeld BsC, GMHE Dackus BsC, RJLF Loffeld MD PhD*
Medical students University of Maastricht, * Department of Internal Medicine Zaans Medisch Centrum
Zaandam The Netherlands.
Treatment of reflux oesophagitis with acid suppressive therapy is effective. However, data on very long term
follow-up are lacking. A study was done in patients in order to assess complaints more than 10 years after the
endoscopic diagnosis.
All patients diagnosed in the years 1998, 1999 and 2000 were studied. Exclusion criteria were chronic cardiopulmonary disease, active treatment for any cancer, immigrants, Alzheimers, mental disability, and psychiatric
illnesses.
All patients received a questionnaire by mail. The questionnaire comprised four different, validated lists of
questions. A general questionnaire consisted of 20 questions on reflux complaints. Severity as well as frequency
was scored on a five and six point Likert scale respectively (scores ranged from 0-40 and 0-60). The GerdQ list,
a symptom activity index (SAI), and the gastrointestinal symptom rating scale (GSRS) were used as well.
In a period of three years 672 patients were diagnosed with reflux oesophagitis. After exclusions the study
population comprised of 410 patients. Of these 208 questionnaires (51%) were available for evaluation.
Complaints were reported by 130 patients (63%). The majority of these, 115 (88%), use acid suppressive
therapy. Only 78 patients were in clinical remission, with or without therapy. The respondents with complaints
were divided into two groups. Group 1: all patients with reflux complaints and using acid suppressive therapy.
Group 2: all patients with complaints without medication.
Patients in group 1 were significantly older at time of the endoscopic diagnosis compared with patients of group
2. Patients in group 1 had significantly more often a hiatal hernia (p<0.001). There was no difference in overall
symptom or frequency score per patient between both groups, mean 5.97 versus 6.8 and 13.4 versus 13.8
respectively. However, heartburn, nausea, acid regurgitation, epigastric pain, dysphagia, and nocturnal
complaints showed a significant higher prevalence in patients of group 2. Scores for specific complaints were
significantly lower in group 2. There was no difference between the GERD-Q, SAI and GSRS.
It is concluded that despite effective therapy only a 37% of patients is in complete remission. However, although
not in remission, the symptom score per patient is rather low. Patients without medication have more often reflux
complaints but lower severity scores, being a possible reason for not taking medication. Hence it is to be
expected that these patients regarded their complaints very mild not necessitating therapy. Patients who still had
complaints and used medication had significantly more often a hiatal hernia seen during the initial endoscopy.