Abstracts
1997 Digestive Disease Week

Gastroesophageal reflux disease as cause of death: analysis of fatal cases under conservative treatment.

JA Salo, T Rantanen, E Kivilaakso. Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland.

The medical treatment of GERD with modern acid suppression agents, such as proton pump inhibitors or H2-antagonists, is postulated to be very effective and safe. Treatment failures are supposed to be rare and there are no reports on the mortality of GERD. Methods and results: In the 1960's the annual mortality of GERD was estimated to be 0.1-0.17/100000. According to the Central Statistical Office of Finland among the 248184 death cases during the 5 year period 1990-1994 there were 78 death certificates, where GERD was the immediate or primary cause of death. The disease histories in the primary health care and hospital records were obtained. After reanalysis 8 operative deaths and 18 pts without proven GERD were excluded. 52 pts (26 M, 26 F, mean age 73, range 8-94) whose nonmalignant GERD was verified at endoscopy (27), autopsy (22) and with typical clinical history with barium swallow (3) were included in the study. The annual mortality rate of conservatively treated GERD was 0.42/100000. The causes of death were nonvariceal esophageal bleeding in 27 pts (52%), complicated by esophageal ulcer in 4 cases, aspiration pneumonia in 18 (35%), perforation of esophageal ulcer in 5 and spontaneous esophageal rupture with reflux esophagitis in 2.

22 pts had been treated with omeprazole, 16 with H2-antagonists, 4 cisapride, 3 alginate acid and antacids and 5 used self medication with antacids. In addition to GERD, 44 pts (85%) had severe concomitant diseases: 12 mental or psychiatric disorders (dementia, mental deficiency, schizophrenia), 11 heart diseases, 8 alcoholism, 7 asthma and/or chronic bronchitis, 6 strokes etc. 12 pts used regularly warfarin, cortisone or NSAIDs. Conclusion: In contrast to the general opinion the mortality in conservatively treated GERD has increased. The effective acid suppression medication does not decrease the mortality of GERD. Patients who have severe concomitant diseases, such as mental disorders, heart diseases or alcoholism, present the risk group among which conservatively treated GERD can be more often fatal. The indication for antireflux surgery among these patients should be re-evaluated.