Associations between different forms of gastro-oesophageal refluxdisease

Abstract
Aims—To study the epidemiology and naturalhistory of gastro-oesophageal reflux disease (GORD).
Methods—Retrospective cohort study involving all172 hospitals of the Department of Veterans Affairs. A total of194 527 patients with GORD were followed between 1981 and 1994. Distribution of oesophagitis, oesophageal ulcer, oesophageal stricture,strictured hiatus hernia, hiatus hernia, and pyrosis by age, sex, andethnicity were determined. The comorbid occurrence of various forms ofGORD in identical patients was analysed by an age and race standardised morbidity ratio. The population of all hospitalised veterans was usedfor comparison.
Results—Severe forms of GORD associated withoesophageal erosions, ulcers, or strictures, affected elderly, white,male patients more often than their corresponding opposite demographicgroup. All forms of GORD clustered in the same patient population; on average, any form of GORD was 10 times more likely to occur in apatient with another form of GORD than without. The highest morbidityratio (22) was found in oesophageal ulcer and stricture. About onethird of all patients with oesophageal erosions, ulcers, or stricturesalso had hiatus hernia; 46% of patients with hiatus hernia werediagnosed as having other forms of GORD. While one third of alloesophageal strictures appeared in patients without other forms of GORDdiagnosed at any time, oesophageal ulcers were always associated withsome other form of GORD. No clear cut progression in different forms ofGORD was found.
Conclusions—Older age, male sex, and whiteethnicity are risk factors in the development of severe forms of GORD.The most severe grade of GORD is reached at the onset of the disease.

Keywords:epidemiology of GORD; erosive oesophagitis; oesophageal stricture; oesophageal ulcer; hiatus hernia; naturalhistory; pyrosis; reflux oesophagitis