Shah Aun, Shibli Fahmi, Kitayama Yoshitaka, Fass Ronnie
The Esophageal and Swallowing Center, Digestive Health Center, Division of Gastroenterology and Hepatology, MetroHealth Medical System, Case Western Reserve University, Cleveland, OH.
J Clin Gastroenterol. 2021 Jan;55(1):12-20. doi: 10.1097/MCG.0000000000001419.
Interpreting natural course studies have been very difficult due to their retrospective design, lack of standardization, reliability of reported mucosal findings, liberal use of antireflux medications and accuracy of chart documentation. Studies provided a wide range of progression rates of patients from nonerosive reflux disease (NERD) to erosive esophagitis (EE). However, direct progression from NERD to Barrett's esophagus appears to be an uncommon phenomenon. Importantly, progression of NERD patients was commonly reported to low grades of EE, which are currently considered inconclusive of gastroesophageal reflux disease. Reports of progression rates from low grades to high grades EE also vary considerably. Progression of patients with EE, without metaplastic epithelium underneath the inflammation, to Barrett's esophagus is relatively uncommon. Recently, it was also recognized that regression from high grades to low grades EE and from EE to NERD is a common phenomenon affecting up to 25% of the patients from each group.
由于其回顾性设计、缺乏标准化、所报告的黏膜检查结果的可靠性、抗反流药物的广泛使用以及病历记录的准确性，解读自然病程研究一直非常困难。研究提供了从非糜烂性反流病（NERD）到糜烂性食管炎（EE）患者的广泛进展率。然而，从NERD直接进展为巴雷特食管似乎是一种不常见的现象。重要的是，NERD患者通常进展为低级别EE，而目前认为这些低级别EE不能确诊为胃食管反流病。从低级别EE到高级别EE的进展率报告也有很大差异。EE患者在炎症下方没有化生上皮的情况下进展为巴雷特食管相对不常见。最近，人们还认识到，从高级别EE到低级别EE以及从EE到NERD的逆转是一种常见现象，每组中高达25%的患者受其影响。
