The acid hypersensitive esophagus (AHE) is characterized by a normal esophageal acid exposure but a significant association between symptoms and reflux episodes. The natural history of AHE remains poorly known. We therefore conducted a follow-up study to compare the initial presentation and natural history of AHE and classical GERD. Quality of life (QOL) was also assessed.
Patients and methods: Two groups of patients referred to our laboratory for 24-hour pH-monitoring (between 1991 and 1996) were compared. Group 1 consisted of 127 consecutive patients with AHE. Group 2 consisted of 101 patients with GERD. All patients were invited by mail to fill-in two questionnaires, the first concerning clinical course and therapeutic needs and the second QOL (questionnaire Reflux-Qual). Finally 62% and 59% of group 1 and 2 respectively did respond to both questionnaires. The corresponding follow-up periods were 4.1 and 4.3 years, respectively.
Results: The two groups did not differ at initial presentation with regard to age, sex, symptoms prevalence and severity of esophagitis (80% of group 1 and 75% of group 2 were endoscopy-negative patients). At an average follow-up of 4 years symptoms persisted in 80% and 71% of patients respectively. Seventy five per cent of patients in both groups continued to take antireflux drugs. QOL scores were similarly reduced in both groups (71 +/- 26 vs 70 +/- 27).
Conclusions: The initial presentation and clinical outcome of AHE and GERD are similar. QOL is notably impaired and the majority of patients continue to receive antireflux medications.