Labenz Joachim, Nocon Marc, Lind Tore, Leodolter Andreas, Jaspersen Daniel, Meyer-Sabellek Wolfgang, Stolte Manfred, Vieth Michael, Willich Stefan N, Malfertheiner Peter
Faculty of Medicine, University of Duisburg/Essen, Ev. Jung-Stilling Hospital, Siegen, Germany.
Am J Gastroenterol. 2006 Nov;101(11):2457-62. doi: 10.1111/j.1572-0241.2006.00829.x. Epub 2006 Oct 4.
There is a controversy as to whether gastroesophageal reflux disease (GERD) exists as a spectrum of disease severity or as a categorial disease in three distinct groups: nonerosive (NERD) and erosive reflux disease (ERD) and Barrett's esophagus (BE). Aim of the study was to assess progression or regression of GERD over 2 yr in a large cohort of patients (N = 3,894) under routine clinical care in Germany, Austria, and Switzerland (ProGERD study).
Patients with predominant heartburn, with or without esophagitis, were recruited and classified according to endoscopic status at baseline, i.e., NERD, erosive reflux disease-Los Angeles (ERD-LA) grade A/B and ERD-LA grade C/D, and BE. After an initial treatment with esomeprazole, they were followed, regardless of their response. Medical therapy or endoscopy was initiated at the discretion of their primary care physician, in line with routine care. At 2 yr, endoscopy with biopsy was performed according to the protocol.
After 2 yr, 25% of patients who had NERD at baseline progressed to LA A/B and 0.6% to LA C/D; 1.6% of patients who had LA A/B progressed to LA C/D and 61% regressed to NERD; 42% of patients who had LA C/D regressed to LA A/B and 50% regressed to NERD (all figures exclude patients with confirmed BE at baseline). At 2 yr, 22% of patients had been off medication for at least 3 months. Patients with ERD-LA grade C/D were at greatest risk of developing BE: 5.8% compared with 1.4% for ERD-LA grade A/B and 0.5% for NERD.
GERD does not seem to be a categorial disease. Progression and regression between grades was observed in this large cohort of patients under routine clinical care.
关于胃食管反流病（GERD）是作为一种疾病严重程度的谱系存在，还是作为三种不同类型的疾病存在，即非糜烂性（NERD）、糜烂性反流病（ERD）和巴雷特食管（BE），存在争议。本研究的目的是在德国、奥地利和瑞士接受常规临床护理的一大群患者（N = 3894）中评估GERD在2年中的进展或逆转情况（ProGERD研究）。
招募以烧心为主、有或无食管炎的患者，并根据基线时的内镜检查情况进行分类，即NERD、洛杉矶糜烂性反流病（ERD-LA）A级/B级和ERD-LA C级/D级，以及BE。在接受埃索美拉唑初始治疗后，无论其反应如何，均对他们进行随访。根据常规护理，由其初级保健医生自行决定开始药物治疗或内镜检查。在2年时，按照方案进行内镜活检。
2年后，基线时患有NERD的患者中有25%进展为LA A/B级，0.6%进展为LA C/D级；患有LA A/B级的患者中有1.6%进展为LA C/D级，61%逆转至NERD；患有LA C/D级的患者中有42%逆转至LA A/B级，50%逆转至NERD（所有数据均不包括基线时确诊为BE的患者）。在2年时，22%的患者已停药至少3个月。ERD-LA C级/D级的患者发生BE的风险最高：为5.8%，而ERD-LA A级/B级为1.4%，NERD为0.5%。
GERD似乎不是一种分类疾病。在这一接受常规临床护理的大量患者队列中观察到了不同级别之间的进展和逆转情况。
