Predicting factors of recurrence in patients with gastroesophageal reflux disease: a prospective follow-up analysis

Abstract

Background: Recurrence of gastroesophageal reflux disease (GERD) is common among patients who are no longer receiving proton pump inhibitors (PPIs). This study investigated factors associated with GERD recurrence. Methods: We included 499 consecutive GERD patients who completed validated reflux and psychological questionnaires before undergoing upper endoscopy. All patients were treated with PPIs and followed up. Results: Recurrence was observed in 89 (30.4%) of 293 patients during the 1-year follow up. Patients with recurrence had a higher prevalence of diabetes mellitus ( p = 0.037), higher baseline GERD Questionnaire (GERDQ) scores ( p = 0.002), and higher Pittsburgh Sleep Quality Index scores ( p = 0.045). Log-rank analysis showed that a GERDQ score of ⩾8 was independently associated with an increased recurrence risk ( p = 0.002). The scores of all psychological questionnaires and health-related quality of life questionnaire worsened more at the end of follow up in patients with recurrence than in those without recurrence. Multivariate analysis revealed that a higher GERDQ score was the only independent risk factor for GERD recurrence ( p = 0.024). GERD patients who have greater initial symptom burden will have a higher recurrence rate after discontinuing PPIs. Conclusions: GERD patients with greater initial symptom burden are more likely to have recurrence after discontinuing PPIs. This study highlights the importance of developing a new strategy to prevent GERD recurrence in the management of this common disorder.