Fullard M, Kang J Y, Neild P, Poullis A, Maxwell J D
Department of Gastroenterology, St George's Hospital, London, UK.
Aliment Pharmacol Ther. 2006 Jul 1;24(1):33-45. doi: 10.1111/j.1365-2036.2006.02963.x.
Gastro-oesophageal reflux disease affects approximately 20% of western populations. Barrett's oesophagus, associated with severe gastro-oesophageal reflux disease, is premalignant and regular endoscopic surveillance is generally performed. In contrast, mild gastro-oesophageal reflux disease is thought not to progress and is not generally subjected to endoscopic follow-up. Aim To investigate whether gastro-oesophageal reflux disease progresses endoscopically.
Systematic review of the literature.
Well-designed prospective studies are few, diagnostic criteria were not always standardized, management strategies varied and various sources of bias could not be excluded. Whilst most patients do not progress to more severe forms of gastro-oesophageal reflux disease, and some cases actually regress, progression is seen in a small proportion of patients. Annual progression rates for non-erosive gastro-oesophageal reflux disease developing erosive oesophagitis ranged from 0% to 30%. About 1-22% of patients with mild erosive oesophagitis developed more severe inflammation annually, while 1-13% of patients with erosive oesophagitis developed Barrett's oesophagus each year.
Although most patients with gastro-oesophageal reflux disease do not progress, and some actually regress, progression does occur in a minority. Better data are required to determine whether patients with mild gastro-oesophageal reflux disease would benefit from increased surveillance with the aim of detecting more advanced disease.
胃食管反流病影响约20%的西方人群。巴雷特食管与严重的胃食管反流病相关，具有恶变倾向，通常需进行定期内镜监测。相比之下，轻度胃食管反流病被认为不会进展，一般不进行内镜随访。目的：研究胃食管反流病在内镜下是否会进展。
对文献进行系统综述。
精心设计的前瞻性研究较少，诊断标准并非总是标准化，管理策略各异，且无法排除各种偏倚来源。虽然大多数患者不会进展为更严重的胃食管反流病形式，有些病例实际上还会好转，但仍有一小部分患者会出现病情进展。非糜烂性胃食管反流病发展为糜烂性食管炎的年进展率为0%至30%。轻度糜烂性食管炎患者每年约有1% - 22%会发展为更严重的炎症，而糜烂性食管炎患者每年有1% - 13%会发展为巴雷特食管。
虽然大多数胃食管反流病患者不会进展，有些实际上还会好转，但仍有少数患者会出现病情进展。需要更好的数据来确定轻度胃食管反流病患者加强监测以发现更晚期疾病是否有益。
