T2015 Multivariate Analysis of Predictors for Severity of Mucosal Lesions in Patients with GERD Symptoms (Mapsomal): A Clinical, Epidemiological and Endoscopic Survey

Abstract

Background: Improvement of symptoms plays a critical role for assessment of treatment outcome in patients with gastroesophageal reflux disease (GERD). Interestingly, most data on long-term outcome of these patients come from clinical trials that assessed the response to treatment in highly standardized trial conditions, with very strict entry criteria and frequent follow-up visits, that are unlikely to be representative of outcomes in standard clinical settings. AIM: To assess the long-term outcome of patients presenting with GERD symptoms for diagnostic work-up in a usual clinical care setting and the clinical predictors of response/ non-response. This abstract summarizes the interim analysis after recruitment of 100 patients. Methods: One hundred patients referred for endoscopic assessment of suspected GERD within a single metropolitan area health service were recruited; 82 consecutive patients from the Royal Adelaide Hospital (RAH) and 28 from the Lyell McEwen Health Centre (LMH). Symptoms and psychological co-morbidities were assessed utilizing the Bowel Disease Ques- tionnaire, the Hospital Anxiety and Depression Scale and the Nepean Dyspepsia Index. Questionnaires were mailed to the patients. Data on endoscopic findings at referral using the Los Angeles (LA) classification were included. As this was an observational study, routine clinical management by the referring GP was not altered. RESULTS: 68 patients were on proton pump inhibitor (PPI) therapy while 31 patients did not receive the treatment. In 58 patients endoscopy revealed no visible esophagitis. The frequency of heartburn was signific- antly associated with the presence of hiatal hernia but the frequency of reflux symptoms was not linked to the presence or severity of endoscopic lesions. Follow-up data > 2 month were available for 38 patients. Out of these 86.8% continued to have heartburn and 76.3% an acid taste after more than 2 months of treatment. The symptomatic response to PPI was significantly better (p<0.01) in GERD patient with hiatal hernia. A greater proportion (24,4% vs 0%) of patients at the RAH had higher grades of oesophagitis (LA C & D) and reported use of non-steroidal anti-inflammatory drugs compared to LMH (p>0.05). 36% of patients reported a history of anxiety and depression but these disorders were not correlated with symptom frequency or response to PPI therapy. Conclusions: a) Frequency of GERD symptoms is not associated with severity of mucosal lesions; b) presence of a hiatal hernia is linked to more frequent symptoms; c) presence of a hiatal hernia predicts a favourable response to PPI therapy.