Universität zu Köln

Fuchs, K. H., DeMeester, T. R., Otte, F., Broderick, R. C., Breithaupt, W., Varga, G. and Musial, F. (2021). Severity of GERD and disease progression. Dis. Esophagus, 34 (10). CARY: OXFORD UNIV PRESS INC. ISSN 1442-2050

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Abstract

Background: Many factors may play a role in the severity and progression of gastroesophageal reflux disease (GERD) since pathophysiology is multifactorial. Data regarding the progression of GERD are controversial: some reports of increased esophageal acid exposure (EAE) and mucosal damage were considered as evidence for a stable disease course, while others interprete these findings as disease progression. The aim of this study is to analyze a large patient-population with persisting symptoms indicative of GERD under protonpumpinhibitor-therapy and identify components characterizing disease severity and progression. Methods: Patients with symptoms indicative of GERD were included in the study in a tertiary referral center (Frankfurt, Germany). All selected patients were under long-term protonpumpinhibitor-therapy with persistant symptoms. All patients underwent investigations to collect data on their physical status, EAE, severity of esophagitis, anatomical changes, and esophageal functional defects as well as their relation to the duration of the disease. Incidence over time was plotted as survival curves and tested with Log-rank tests for the four main disease markers. Multivariate modeling with COX-regression model was used to estimate the general impact of the four main disease markers on the time course of the disease. In order to elucidate possible causal relationships over time, a path analysis (structural equation model) was calculated. Results: From the database with 1480 data sets, 972 patients were evaluated (542 males, 430 females). The mean age was 50.5 years (rangel8-89). The mean body mass index was 27.2(19-48). The mean time between the onset of symptoms and the diagnostic investigations was 8.2 years (1-50). A longer disease history for GERD was significantly associated with a higher risk for LES-incompetence. The mean duration from symptom onset to the time of clinical investigation was 9 years for patients with LES-incompetence (n = 563), compared to a mean of 6 years for those with mechanically intact LES (n = 95). A longer period from symptom onset to diagnostics was significantly associated with higher acid exposure. The pathway analysis was significant for the following model: 'history' (P < 0.001 -> LES-incompetence & Hiatal Hernia ->(p < 0,001)-> pH-score (P < 0.001). Conclusion: LES-incompetence, the functional deterioration of the LES, and the anatomical alteration at the esophagogastric junction (Hiatal Hernia) as well as an increased EAE were associated with a long history of suffering from GERD. Path modeling suggests a causal sequence overtime of the main disease-parameters, tentatively allowing for a prediction of the course of the disease.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Fuchs, K. H. UNSPECIFIED UNSPECIFIED UNSPECIFIED DeMeester, T. R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Otte, F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Broderick, R. C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Breithaupt, W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Varga, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Musial, F. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-589624
DOI:	10.1093/dote/doab006
Journal or Publication Title:	Dis. Esophagus
Volume:	34
Number:	10
Date:	2021
Publisher:	OXFORD UNIV PRESS INC
Place of Publication:	CARY
ISSN:	1442-2050
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language GASTROESOPHAGEAL-REFLUX-DISEASE; LOWER ESOPHAGEAL SPHINCTER; BARRETTS-ESOPHAGUS; HIATAL-HERNIA; PATHOPHYSIOLOGY; INCOMPETENCE; DEFINITION; SPECTRUM; ACID Multiple languages Gastroenterology & Hepatology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/58962