Schindlbeck N E, Klauser A G, Berghammer G, Londong W, Müller-Lissner S A
Department of Gastroenterology, University of Munich, Germany.
Gut. 1992 Aug;33(8):1016-9. doi: 10.1136/gut.33.8.1016.
Data on the natural course of gastrooesophageal reflux disease are sparse. One hundred and sixty six patients with typical reflux symptoms (heartburn and/or acid regurgitation) and pathologic pH monitoring (reflux time > 8.2% upright and/or > 3.0% supine) were studied. The patients were followed up by questionnaire and interview for a mean of 41 (seven to 86) months after diagnosis of reflux disease. Ten patients had died of diseases not reflux related. In 117 (75%) of the remaining 156 patients data on the course of gastrooesophageal reflux disease could be obtained. In 12 patients anti reflux surgery had been performed. Forty one (39%) of the remaining 105 patients have stopped taking medical therapy, in 13 of these patients symptoms had completely disappeared. Sixty four patients continued on medication (40 on demand, 24 regularly). When asked how their symptoms would be if they completely stopped medication, 71 patients considered their symptoms to be equal or worse and 21 patients to be improved as compared with the initial investigation. Patients with persisting symptoms at follow up had significantly more supine reflux (p < 0.05) at the initial pH monitoring as compared with patients with improved symptoms. The presence and grade of oesophageal erosions at initial endoscopy, duration of symptoms, age, sex, and smoking habits had no influence on the course of gastrooesophageal reflux disease. In conclusion, reflux symptoms disappear only in a minority of patients with proven gastrooesophageal reflux disease. More than half of all patients continue medication, either on demand or regularly. Severe supine reflux is an unfavourable prognostic factor.
关于胃食管反流病自然病程的数据较为稀少。对166例有典型反流症状（烧心和/或反酸）且pH监测结果异常（直立位反流时间>8.2%和/或仰卧位反流时间>3.0%）的患者进行了研究。在诊断反流病后，通过问卷调查和访谈对患者进行了平均41（7至86）个月的随访。10例患者死于与反流无关的疾病。在其余156例患者中的117例（75%）可获得胃食管反流病病程的数据。12例患者接受了抗反流手术。其余105例患者中有41例（39%）停止了药物治疗，其中13例患者症状完全消失。64例患者继续用药（40例按需用药，24例规律用药）。当被问及如果完全停止用药症状会如何时，71例患者认为症状与初始检查时相同或更严重，21例患者认为症状有所改善。随访时仍有症状的患者在初始pH监测时仰卧位反流明显更多（p<0.05），与症状改善的患者相比。初始内镜检查时食管糜烂的存在及程度、症状持续时间、年龄、性别和吸烟习惯对胃食管反流病的病程无影响。总之，在已证实患有胃食管反流病的患者中，只有少数患者的反流症状会消失。超过一半的患者继续用药，按需或规律用药。严重的仰卧位反流是一个不利的预后因素。
