Purpose: It is controversial if non-erosive reflux disease (NERD) and erosive esophagitis (EE) form a continuum of a single disease or if they are manifestations of two different pathophysiological disease entities. We therefore reviewed the ReQuest™ database (of patients with well characterized reflux disease) to determine the proportions of male and female patients with NERD and with EE of different grades of severity.
Methods: The ReQuest™ database contains data from 2 NERD and 12 EE clinical trials with symptom assessment based on the reflux questionnaire ReQuest™. 10 EE clinical trials enrolled patients with severity grades A-D, the other 2 EE studies included patients with severity grades B-D (Los Angeles classification). Baseline demographics and characteristics of 6,810 per-protocol patients were analyzed.
Results: Of these patients, 964 had NERD and 5,846 suffered from EE [grade A: 2,309 (33.9%); grade B: 2,755 (40.5%); grade C: 637 (9.4%); grade D: 145 (2.1%)]. A greater proportion of NERD patients were females (61.3%). More females with EE had mild disease (grade A), whereas a higher proportion of male patients had more severe disease (grades C and D).
Conclusions: GERD in females is characterized by a higher proportion of NERD compared with men; and when EE is present, the proportion of a mild disease course (grade A) is also higher than in men. The fact that women presenting with GERD symptoms have less severe alteration of the esophageal mucosa, raises the possibility that this observation reflects genetically determined differences in visceral sensitivity amongst men and women to exposure of gastroesophageal reflux.
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