Gastroenterology

Gastroenterology

Volume 125, Issue 6, December 2003, Pages 1670-1677
Gastroenterology

Clinical-alimentary tract
Screening for Barrett’s esophagus in colonoscopy patients with and without heartburn☆

https://doi.org/10.1053/j.gastro.2003.09.030Get rights and content

Abstract

Background & Aims: The population prevalence of Barrett’s esophagus (BE) is uncertain. Our aim was to describe the prevalence of BE in a volunteer population. Methods: Upper endoscopy (EGD) was performed in 961 persons with no prior history of EGD who were scheduled for colonoscopy. Symptom questionnaires were completed prior to endoscopy. Biopsy specimens were taken from the gastric cardia and any columnar mucosa extending ≥5 mm into the tubular esophagus and from the stomach for H. pylori infection in the last 812 patients. Results: The study sample was biased toward persons undergoing colonoscopy, males, and persons with upper GI symptoms. The prevalence of BE was 65 of 961 (6.8%) patients, including 12 (1.2%) with long-segment BE (LSBE). Among 556 subjects who had never had heartburn, the prevalences of BE and LSBE were 5.6% and 0.36%, respectively. Among 384 subjects with a history of any heartburn, the prevalences of BE and LSBE were 8.3% and 2.6%, respectively. In a univariate analysis, LSBE was more common in those with any heartburn vs. those with no heartburn (P = 0.01), but the sample size was insufficient to allow multivariate analysis of predictors of LSBE. In a multivariate analysis, BE was associated with increasing age (P = 0.02), white race (P = 0.03), and negative H. pylori status (P = 0.04). Overall, BE was not associated with heartburn, although heartburn was more common in persons with LSBE or circumferential short segments. Conclusions: LSBE is very uncommon in patients who have no history of heartburn. SSBE is relatively common in persons age ≥40 years with no prior endoscopy, irrespective of heartburn history.

Section snippets

Materials and methods

The study was approved by the human research committees at each participating institution. Patients were considered eligible if they were age 40 years or older, had never undergone colonoscopy, were scheduled for colonoscopy, and preferred to have colonoscopy with sedation. If the patient identified a symptom (e.g., vomiting, dysphagia, upper abdominal pain, clinically important weight loss) or laboratory finding (e.g., anemia) that was an accepted indication for upper endoscopy, the patient

Study population

Among the 961 study subjects, the mean age was 59 years, 572 (59.5%) were male, 750 (78%) were white, 196 (20.3%) were black, and 15 (1.6%) were Latin-American or Asian. Seventeen percent of the subjects were current smokers and 39% had never smoked. Fifty percent of the subjects used less than 1 alcoholic drink per week, and 4.1% had 10 or more drinks per week. The percentage of patients who never experienced heartburn was 59.1%, heartburn less than once per week was reported by 25.1%, 6.4%

Discussion

In this report, we describe the prevalence of BE in 961 persons who were undergoing colonoscopy and who were invited on the day of the colonoscopy to undergo a free sedated upper endoscopy with biopsies just prior to the colonoscopy. Our study sample was biased toward persons undergoing colonoscopy, who almost surely have more gastrointestinal symptoms than the general population and who may have more GERD symptoms. Evaluation of persons refusing to participate demonstrated that our study

Acknowledgements

The authors thank Yvonne Romero, M.D., for the Reflux Symptom Questionnaire, which is copyrighted by the Mayo Foundation, Rochester, Minnesota, and Susan Adlis for performing the calculations of survey responses and the multivariable analyses.

References (57)

  • S. Dhillon et al.

    Concurrent validity and reproducibility characteristics of the reflux symptoms questionnaire and the reflux symptoms questionnaire 1-W

    Am J Gastroenterol

    (2002)
  • G.R. Locke et al.

    A new questionnaire for gastroesophageal reflux disease

    Mayo Clin Proc

    (1994)
  • W. Hirota et al.

    Specialized intestinal metaplasia, dysplasia and cancer of the esophagus and esophagogastric junctionprevalence and clinical data

    Gastroenterology

    (1999)
  • S.J. Spechler et al.

    Prevalence of metaplasia at the gastro-oesophageal junction

    Lancet

    (1994)
  • A.H. Ormsby et al.

    Cytokeratin immunoreactivity patterns in the diagnosis of short-segment Barrett’s esophagus

    Gastroenterology

    (2000)
  • H.M. El-Zimaity et al.

    Cytokeratin subsets for distinguishing Barrett’s esophagus from intestinal metaplasia in the cardia using endoscopic biopsy specimens

    Am J Gastroenterol

    (2001)
  • J.M. Ransom et al.

    Extended and limited types of Barrett’s esophagus in the adult

    Ann Thorac Surg

    (1982)
  • I.A. Harle et al.

    Management of adenocarcinoma in columnar-lined esophagus

    Ann Thorac Surg

    (1985)
  • A.P. Weston et al.

    Prospective multivariate analysis of clinical, endoscopic, and histologic factors predictive of the development of Barrett’s multifocal high-grade dysplasia or adenocarcinoma

    Am J Gastroenterol

    (1999)
  • L.B. Gerson et al.

    Prevalence of Barrett’s esophagus in asymptomatic individuals

    Gastroenterology

    (2002)
  • S. Hamilton et al.

    Prevalence and characteristics of Barrett’s esophagus in patients with adenocarcinoma of the esophagus or esophagogastric junction

    Hum Pathol

    (1988)
  • M. Guelrud et al.

    Enhanced magnification endoscopya new technique to identify specialized intestinal metaplasia in Barrett’s esophagus

    Gastrointest Endosc

    (2001)
  • M.I. Canto et al.

    Methylene blue-directed biopsies improve detection of intestinal metaplasia and dysplasia in Barrett’s esophagus

    Gastrointest Endosc

    (2000)
  • R. Kiesslich et al.

    Screening for specialized columnar epithelium with methylene bluechromoendoscopy in patients with Barrett’s esophagus and a normal control group

    Gastrointest Endosc

    (2001)
  • P. Sharma et al.

    Methylene blue chromoendoscopy for detection of short segment Barrett’s esophagus

    Gastrointest Endosc

    (2001)
  • J.M. Daly et al.

    National Cancer Data Base report on esophageal carcinoma

    Cancer

    (1996)
  • W.J. Blot et al.

    Rising incidence of adenocarcinoma of the esophagus and gastric cardia

    JAMA

    (1991)
  • J. Lagergren et al.

    Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma

    N Engl J Med

    (1999)

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    ☆

    Supported in part by Astra-Zeneca, by the American Society for Gastrointestinal Endoscopy, and by Boston-Scientific (Microvasive).

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    Copyright © 2003 American Gastroenterological Association. Published by Elsevier Inc. All rights reserved.