Erosive Gerd Erd

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The above quoted paper by Fass states that "patients with erosive esophagitis tend to remain within this group during their lifetime" and that Barrett's mucosa does not progress or regress over time, and thus patients continue to harbor this type of lesion as long as they live. In fact this is not true, as transition to Barretts esophagus and to adenocarcinoma has been reported, the latter even in the absence of BE as an intermediate lesion. We have already mentioned the 11% of new developed BE observed in the study by McDougall; Lagergren etal [18] have demonstrated that the risk of adenocarcinoma of the esophagus is much more related to the duration and severity of gastroesophageal reflux disease than to the presence of Barrett's esophagus, and therefore the latter could be considered to be "a common, but not necessary step, in the evolution of esophageal adenocarcinoma" [18]. Similar observations have subsequently been done by Chow et al [19] and by Farrow et al [20].

Conio et al [21], in a retrospective survey, were able to demonstrate that in the Olmsted County many adenocarcinomas of the esophagus occurred in patients without a previous diagnosis of Barrett's esophagus. All these studies represent arguments against the statement that most erosive patients tend to remain in this group, but rather show that a transition from the less to the most advanced segment of the GERD spectrum is possible.

Finally, it has been shown already since many years [22], and has recently been confirmed [23] that, during the course of the erosive-ulcerative disease, the esophagus is involved in a slow but progressive process of "shrinkage'' which determines not only a progressive weakness of the anti-reflux mechanism represented by LES length and position, but also the formation of an "endobrachyesophagus'', which, to use a more modern terminology, is synonymous with circular long-segment Barrett's esophagus.

Thus, the progression of the disease in this group of patients is not only suggested by epidemiological evidence but is also biologically plausible and clinically confirmed.

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