Path Modeling Helps Predict Disease Course in Patients With GERD

Researchers aimed to identify disease markers in GERD to describe its progression and severity in patients with persisting symptoms.

Path modeling suggests a causal sequence over time for the main disease parameters in patients with gastroesophageal reflux disease (GERD), thereby allowing for a prediction of the disease course, according to a study published in Diseases of the Esophagus.

Data on the progression of GERD is controversial. Some reports of increased esophageal acid exposure (EAE) and mucosal damage are considered evidence for a stable disease course, while others interpret these findings as disease progression. Consequently, researchers analyzed a large patient cohort with persisting symptoms indicative of GERD, who were on long-term proton pump inhibitor therapy. This analysis was performed to identify components of disease severity and progression

The researchers evaluated 972 patients with a mean age of 50.5 years, a mean body mass index of 27.2, and a mean time between symptom onset and diagnostic investigations of 8.2 years.

They found that a longer disease history of GERD was significantly associated with a higher risk for lower esophageal sphincter (LES) incompetence. The mean duration from symptom onset to the time of clinical investigation was 9 years for patients with LES incompetence (n=563), compared to 6 years for those with a mechanically intact LES (n=95). A longer period between symptom onset and diagnosis was significantly associated with higher acid exposure.

To elucidate possible causal relationships over time, a path analysis was calculated.  The following model was significant:

‘History’ (P <.001➔LES-Incompetence & Hiatal Hernia➔(P <.001)➔pH-score (P <.001).

The authors concluded, “LES-incompetence, the functional deterioration of the LES, and the anatomical alteration at the esophagogastric junction (Hiatal Hernia) as well as an increased EAE were associated with a long history of suffering from GERD.”

They added, “Path modeling supports a causal sequence of developing these disease-parameters over time.”


Fuchs KH, DeMeester TR, Otte F, et al. Severity of GERD and disease progression. Dis Esophagus. Published online February 11, 2021. doi:10.1093/dote/doab006