Journal Article

Gastro-Esophageal Reflux Disease Symptoms and Demographic Factors as a Pre-Screening Tool for Barrett’s Esophagus

Burnham, Rodney W., Wong, Angela, Corovic, Andrej, Fitzgerald, Rebecca C., Lovat, Laurence B., O’Donovan, Maria, Lao-Sirieix, Pierre, Liu, Xinxue, Kadri, Sudarshan R.

2014

Overview

Barrett's esophagus (BE) occurs as consequence of reflux and is a risk factor for esophageal adenocarcinoma. The current \"gold-standard\" for diagnosing BE is endoscopy which remains prohibitively expensive and impractical as a population screening tool. We aimed to develop a pre-screening tool to aid decision making for diagnostic referrals. A prospective (training) cohort of 1603 patients attending for endoscopy was used for identification of risk factors to develop a risk prediction model. Factors associated with BE in the univariate analysis were selected to develop prediction models that were validated in an independent, external cohort of 477 non-BE patients referred for endoscopy with symptoms of reflux or dyspepsia. Two prediction models were developed separately for columnar lined epithelium (CLE) of any length and using a stricter definition of intestinal metaplasia (IM) with segments ≥ 2 cm with areas under the ROC curves (AUC) of 0.72 (95%CI: 0.67-0.77) and 0.81 (95%CI: 0.76-0.86), respectively. The two prediction models included demographics (age, sex), symptoms (heartburn, acid reflux, chest pain, abdominal pain) and medication for \"stomach\" symptoms. These two models were validated in the independent cohort with AUCs of 0.61 (95%CI: 0.54-0.68) and 0.64 (95%CI: 0.52-0.77) for CLE and IM ≥ 2 cm, respectively. We have identified and validated two prediction models for CLE and IM ≥ 2 cm. Both models have fair prediction accuracies and can select out around 20% of individuals unlikely to benefit from investigation for Barrett's esophagus. Such prediction models have the potential to generate useful cost-savings for BE screening among the symptomatic population.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adenocarcinoma / Adult / Aged / Analysis / Barrett Esophagus - diagnosis / Barrett Esophagus - epidemiology / Barrett Esophagus - etiology / Barrett's esophagus / Biology and Life Sciences / Cancer / Care and treatment / Cost analysis / Cross-Sectional Studies / Decision making / Demographics / Demography / Diagnosis / Diagnostic software / Diagnostic systems / Drugs / Dyspepsia / Endoscopy / Epithelium / Esophageal cancer / Esophagus / Ethics / Female / Gastroenterology / Gastroesophageal reflux / Gastroesophageal Reflux - complications / Gastroesophageal Reflux - diagnosis / Gastroesophageal Reflux - epidemiology / Genetic aspects / Health risk assessment / Humans / Intestine / Male / Mass Screening / Mathematical models / Medical screening / Medicine and Health Sciences / Metaplasia / Middle Aged / Model accuracy / Pain / Patients / Population / Prediction models / Primary care / Questionnaires / Reproducibility of Results / Research and Analysis Methods / Risk analysis / Risk Factors / ROC Curve / Stomach / Studies / Surveillance / Young Adult