Long-term complications to reflux disease in community practice. A 17-year cohort study of 4706 patients

• Published in: Scandinavian journal of gastroenterology 2011-10, Vol.46 (10), p.1179-1186
• Main Authors: Hvid-Jensen, Frederik, Pedersen, Lars, Munk, Estrid Muff, Drewes, Asbjørn Mohr, Funch-Jensen, Peter
• Format: Article
• Language: English
• Subjects: Alcoholism - complications; Biological and medical sciences; Catheterization; Cohort Studies; Community Health Services; Denmark - epidemiology; esophageal stenosis; Esophageal Stenosis - epidemiology; Esophageal Stenosis - etiology; Esophageal Stenosis - therapy; Esophagitis, Peptic - complications; Esophagitis, Peptic - epidemiology; Esophagus; esophagus stricture; Female; gastresophageal reflux; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - drug therapy; human; Humans; Incidence; Kaplan-Meier Estimate; major clinical study; Male; Medical sciences; Middle Aged; Other diseases. Semiology; population research; Proportional Hazards Models; Proton Pump Inhibitors - therapeutic use; risk factor; Sex Factors
• ISSN: 0036-5521; 1502-7708
• DOI: 10.3109/00365521.2011.594084

Abstract Objective. To examine the risk of developing strictures in patients with erosive and non-erosive gastroesophageal reflux disease in a community-based setting, since controlled trials indicate that the use of proton pump inhibitors renders the risk of strictures insignificant. Material and methods. A 17-year cohort study of 4706 patients referred to endoscopy due to upper GI symptoms, with a population comparison cohort of 47,060 individuals. All patients were followed and treated according to prevailing guidelines by their usual care provider. Main outcomes were relative risks (RR) and 95% confidence intervals (CI) for incident strictures and dilatations. Results. 776 (16.5%) patients were diagnosed with erosive esophagitis, particularly men (61.2%). Over a period of 1-17 years (mean 10.5), 20 patients (2.6%) in the esophagitis group developed a peptic stricture, necessitating one or more dilatations in 16 patients (2.1%). Among the non-esophagitis patients, the incidences for both outcomes were 1.2%. Male gender doubled the risk of developing strictures, and alcohol abuse raised the risk four folds. Erosive patients had a risk of developing strictures eight times (95% CI: 5.0-13.0) higher than controls, whereas non-erosive patients' risk was 4.0 (95% CI: 2.8-5.7). The majority of strictures developed within the first 10 years after a diagnosis of esophagitis. Conclusion. Patients with esophagitis had eight times higher risk of strictures than population controls and two times higher than dyspeptic patients without esophagitis. This indicates that long-term outcomes in general practice are poorer than in controlled trials, most likely due to a lack of compliance with medication.