Risk factors for the detection of Barrett's esophagus in patients with erosive esophagitis

Nir Modiano, Lauren B. Gerson

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Barrett's esophagus (BE) results from metaplastic healing of injured esophageal mucosa after erosive esophagitis (EE). Objective: Our purpose was to determine whether severity of esophagitis, indication for endoscopy, or proton pump inhibitor treatment affects the subsequent incidence of BE diagnosis in patients found to have EE on EGD performed for any indication. Design: We identified patients with primary or secondary International Classification of Diseases, 9th revision diagnosis codes of EE from 1996 to 2006 who had at least 2 EGDs on record. Patients with prevalent BE on the first EGD were excluded. Setting: Inpatients and outpatients at Stanford University and Palo Alto Veterans Affairs Health Care System. Interventions: Retrospective review of EGD and pathology reports to confirm BE. Main Outcome Measurements: Detection of BE after diagnosis of EE. Results: A total of 1095 patients were identified between 1996 and 2000, and 102 (9%) were included. Sixty-two (61%) patients were veterans, 87 (85%) were male, and 83 (81%) were white. The mean (±SD) age was 58 ± 14 years (range 24-83 years). BE was detected in 9 (9%) patients (95% CI, 4.5%-17.6%) over a mean of 13.3 ± 5.7 months (range 1-53.5 months), and all had prior grade 4 esophagitis. The mean BE length was 4 ± 1.8 cm (range 1-18 cm). Six patients had upper GI bleeding as the indication for EGD, whereas the other 3 complained of dysphagia. The association of grade 4 esophagitis (P = .01) and GI hemorrhage (P = .01) to the subsequent detection of BE was highly statistically significant. Limitations: Retrospective study, small number of patients with BE after EE. All patients were receiving care at tertiary medical centers. Conclusions: BE was detected in 9% of patients with prior EE and was detected exclusively on follow-up of patients with severe esophagitis. The majority of the patients found to have BE had upper GI bleeding as the presentation for EGD.

Original languageEnglish (US)
Pages (from-to)1014-1020
Number of pages7
JournalGastrointestinal Endoscopy
Volume69
Issue number6
DOIs
StatePublished - May 2009
Externally publishedYes

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Barrett Esophagus
Esophagitis
Hemorrhage
Veterans Health
Proton Pump Inhibitors
International Classification of Diseases
Veterans
Tertiary Healthcare
Deglutition Disorders
Endoscopy
Inpatients
Outpatients
Retrospective Studies

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Risk factors for the detection of Barrett's esophagus in patients with erosive esophagitis. / Modiano, Nir; Gerson, Lauren B.

In: Gastrointestinal Endoscopy, Vol. 69, No. 6, 05.2009, p. 1014-1020.

Research output: Contribution to journalArticle

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abstract = "Background: Barrett's esophagus (BE) results from metaplastic healing of injured esophageal mucosa after erosive esophagitis (EE). Objective: Our purpose was to determine whether severity of esophagitis, indication for endoscopy, or proton pump inhibitor treatment affects the subsequent incidence of BE diagnosis in patients found to have EE on EGD performed for any indication. Design: We identified patients with primary or secondary International Classification of Diseases, 9th revision diagnosis codes of EE from 1996 to 2006 who had at least 2 EGDs on record. Patients with prevalent BE on the first EGD were excluded. Setting: Inpatients and outpatients at Stanford University and Palo Alto Veterans Affairs Health Care System. Interventions: Retrospective review of EGD and pathology reports to confirm BE. Main Outcome Measurements: Detection of BE after diagnosis of EE. Results: A total of 1095 patients were identified between 1996 and 2000, and 102 (9{\%}) were included. Sixty-two (61{\%}) patients were veterans, 87 (85{\%}) were male, and 83 (81{\%}) were white. The mean (±SD) age was 58 ± 14 years (range 24-83 years). BE was detected in 9 (9{\%}) patients (95{\%} CI, 4.5{\%}-17.6{\%}) over a mean of 13.3 ± 5.7 months (range 1-53.5 months), and all had prior grade 4 esophagitis. The mean BE length was 4 ± 1.8 cm (range 1-18 cm). Six patients had upper GI bleeding as the indication for EGD, whereas the other 3 complained of dysphagia. The association of grade 4 esophagitis (P = .01) and GI hemorrhage (P = .01) to the subsequent detection of BE was highly statistically significant. Limitations: Retrospective study, small number of patients with BE after EE. All patients were receiving care at tertiary medical centers. Conclusions: BE was detected in 9{\%} of patients with prior EE and was detected exclusively on follow-up of patients with severe esophagitis. The majority of the patients found to have BE had upper GI bleeding as the presentation for EGD.",
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