Natural history of gastroesophageal reflux: A prospective cohort study in a stratified randomized population in Beijing

OBJECTIVE: To explore the natural history of and risk factors for gastroesophageal reflux (GER) in a prospective cohort in Beijing, China. METHODS: We selected adult participants using a stratified randomized method and performed initial surveys in 1996 and the current survey in 2008. Well-trained investigators administered the survey questionnaire using face-to-face interviews. Reflux symptoms were evaluated by their intensity and frequency. GER was defined as heartburn, acid reflux, and food regurgitation at least once a week, and monthly reflux was defined as at least one of the above symptoms occurring 1-3 days per month. RESULTS: The resurvey response rate was 47.8% (1189/2486). Over 12 years, 66.9% of the respondents remained unchanged, and one-third changed, with a GER new onset rate of 7.0 per 1000 person-years and a GER disappearance rate of 64.6 per 1000 person-years. This kept the GER prevalence stable at 8.2% to 9.5% (P = 0.28). GER and monthly reflux exhibited significant differences in their tendency to persist or become aggravated to GER (22.4% vs 11.9%, P = 0.02). Participants who initially had single, mild to moderate, daily GER were more likely to recover from reflux over time. Participants with persistent and aggravated GER had more severe heartburn and acid reflux than those with new-onset GER in the current survey. Multiple logistic regression analysis showed that emotional depression is a risk factor for GER aggravation (odds ratio 3.52, 95% confidence interval 1.43-8.67, P = 0.006). CONCLUSION: The initial symptom profile of reflux determines the outcome of GER over time.