OBJECTIVES: 1. To determine the progression of endoscopic affectation in patients with gastroesophageal reflux disease (GERD). 2. To analyze the clinical parameters associated to grade IV of esophagitis, as well as the degree of endoscopic progression. MATERIAL AND METHODS: between 1996 and 2002, 692 patients with GERD have been followed prospectively (66% men and 33% women, with a mean age of 50.7 years). All were submitted to initial upper endoscopy, without treatment, and different clinical parameters associated to grade IV esophagitis were analyzed. During follow up, a new endoscopy was repeated in the event of symptomatic relapse, comparing the new findings with those of the initial exploration. RESULTS: the initial endoscopy did not reveal signs of esophagitis in 49% of the patients. Grade I 11.2%, grade II 22%, grade III 8.1% and grade IV 8.7%. Multivariant analysis showed that advanced age (p <0.01), male sex (p <0.03), smoking (p <0.02) and absence of infection due to Helicobacter pylori (p <0.02) were independent factors associated to grade IV esophagitis. Throughout follow up, patients without esophagitis did not show evidence of esophagitis in successive endoscopies, and a higher grade was found in only 3 of the patients. CONCLUSIONS: the endoscopy did not reveal signs of esophagitis in approximately half of the patients. Advanced age, male sex, smoking and absence of Helicobacter pylori are risk factors associated with severe stages of esophagitis. Patients with reflux without esophagitis did not develop inflammatory disorders during follow-up, while those with esophagitis remained in the stage of the initial diagnosis.
OBJECTIVES: 1. To determine the progression of endoscopic affectation in patients with gastroesophageal reflux disease (GERD). 2. To analyze the clinical parameters associated to grade IV of esophagitis, as well as the degree of endoscopic progression. MATERIAL AND METHODS: between 1996 and 2002, 692 patients with GERD have been followed prospectively (66% men and 33% women, with a mean age of 50.7 years). All were submitted to initial upper endoscopy, without treatment, and different clinical parameters associated to grade IV esophagitis were analyzed. During follow up, a new endoscopy was repeated in the event of symptomatic relapse, comparing the new findings with those of the initial exploration. RESULTS: the initial endoscopy did not reveal signs of esophagitis in 49% of the patients. Grade I 11.2%, grade II 22%, grade III 8.1% and grade IV 8.7%. Multivariant analysis showed that advanced age (p <0.01), male sex (p <0.03), smoking (p <0.02) and absence of infection due to Helicobacter pylori (p <0.02) were independent factors associated to grade IV esophagitis. Throughout follow up, patients without esophagitis did not show evidence of esophagitis in successive endoscopies, and a higher grade was found in only 3 of the patients. CONCLUSIONS: the endoscopy did not reveal signs of esophagitis in approximately half of the patients. Advanced age, male sex, smoking and absence of Helicobacter pylori are risk factors associated with severe stages of esophagitis. Patients with reflux without esophagitis did not develop inflammatory disorders during follow-up, while those with esophagitis remained in the stage of the initial diagnosis.