Screening for Barrett's esophagus in colonoscopy patients with and without heartburn

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 > or =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 > or =40 years with no prior endoscopy, irrespective of heartburn history.     

Prevalence and risk factors of Barrett's esophagus in patients undergoing endoscopy for upper gastrointestinal symptoms

OBJECTIVE: To investigate the prevalence of Barrett's esophagus (BE) and its risk factors in patients undergoing endoscopy for upper gastrointestinal symptoms in a Chinese tertiary referral medical center. METHODS: All consecutive patients receiving an endoscopy for upper gastrointestinal symptoms in our medical center from September to December 2007 were recruited. BE was explored for at endoscopy when a suspected columnar-lined esophagus was found. Patients with specialized intestinal metaplasia in the distal esophagus were defined as having BE. RESULTS: A total of 2022 patients (1053 male and 969 female) were recruited. The patients were aged 18 to 88 years and with a mean age of 46.97 ± 14.84 years. BE was found in 21 patients (15 male and 6 female), a prevalence of 1.0% of all patients receiving endoscopy for upper gastrointestinal symptoms in our medical center. One of the 21 patients had low-grade dysplasia. By logistic multivariate analysis, age (OR 1.03; 95% CI, 1.00, 1.07) and reflux esophagitis (OR 4.44; 95% CI, 1.22, 16.17) were factors associated significantly with BE. CONCLUSION: The prevalence of BE in our study was lower than that reported in other studies, especially in studies from developed countries. Older age and reflux esophagitis may be the risk factors for developing BE.     

Gastroesophageal reflux among different racial groups in the United States

BACKGROUND & AIMS: White people in the United States are several-fold more affected by esophageal adenocarcinoma than black people. It remains unknown whether this racial discrepancy reflects a higher prevalence of gastroesophageal reflux disease (GERD) symptoms or a higher degree of esophageal damage. METHODS: A cross-sectional survey followed by endoscopy was performed among employees at a VA medical center. The association between race and GERD symptoms and erosive esophagitis was analyzed in logistic regression analyses controlling for demographic, clinical, and histologic variables. RESULTS: A total of 496 of 915 people (54%) returned interpretable questionnaires, and endoscopy was performed in 215 participants. The mean age was 45 years, and 336 (68%) were women. Racial distribution was 43% black, 34% white, and 23% other races. Heartburn occurring at least weekly was reported in 27%, 23%, and 24% of these racial groups, respectively. The age-adjusted prevalence of heartburn or regurgitation was not significantly different among the groups. Erosive esophagitis was found in 50 of 215 participants (23%); 31 of these cases were mild. Only one person had Barrett's esophagus (0.4%). For weekly heartburn or regurgitation, black participants had significantly less frequent erosive esophagitis than white participants (24% vs. 50%; P = 0.03). With multiple adjustments, black participants had a persistently lower risk of esophagitis (adjusted odds ratio, 0.22-0.46; P < 0.001). CONCLUSIONS: White and black people in the United States have a similarly high prevalence of GERD symptoms. However, black people have a lower prevalence of esophagitis for the same frequency of GERD symptoms. Barrett's esophagus was rare in this study, even among those with frequent symptoms.     

Barrett＇s esophagus： Prevalence and risk factors in patients with chronic GERD in Upper Egypt

AIM： To determine the prevalence and possible risk factors of Barrett＇s esophagus （BE） in patients with chronic gastroesophageal reflux disease （GERD） in EI Minya and Assuit, Upper Egypt. METHODS： One thousand consecutive patients with chronic GERD symptoms were included in the study over 2 years. They were subjected to history taking including a questionnaire for GERD symptoms, clinical examination and upper digestive tract endoscopy. Endoscopic signs suggestive of columnar-lined esophagus （CLE） were defined as mucosal tongues or an upward shift of the squamocolumnar junction. BF was diagnosed by pathological examination when specialized intestinal metaplasia was detected histologically in suspected CLE. pH was monitored in 40 patients. RESULTS： BE was present in 7.3% of patients with chronic GERD symptoms, with a mean age of 48.3 ± 8.2 years, which was significantly higher than patients with GERD without BE （37.4 ± 13.6 years）. Adenocarcinoma was detected in eight cases （0.8%）, six of them in BE patients. There was no significant difference between patients with BE and GERD regarding sex, smoking, alcohol consumption or symptoms of GERD. Patients with BE had significantly longer esophageal acid exposure time in the supine position, measured by pH monitoring. CONCLUSION： The prevalence of BE in patients with GERD who were referred for endoscopy was 7.3%. BE seems to be associated with older age and more in patients with nocturnal gastroesophageal reflux.     

Barrett's esophagus and endoscopically assessed esophagogastric junction integrity in 1000 consecutive Turkish patients undergoing endoscopy: a prospective study

Barrett's esophagus (BE) appears to be more common in Western than in Asian countries. BE is a complication of gastroesophageal reflux disease (GERD). Anatomical abnormalities of the esophagogastric junction (EGJ) are an important factor in the pathogenesis of GERD. We aimed to determine the prevalence of BE in Turkey, which is geographically located between Europe and Asia, and to investigate the frequency of BE according to the degree of anatomical disruption in the EGJ. This prospective study was performed on 1000 consecutive patients referred for endoscopy for any clinical indication. All patients underwent a structured interview that assessed major symptoms of GERD (regurgitation and heartburn). BE was diagnosed when specialized intestinal metaplasia was detected histologically in the esophageal biopsy specimens. Endoscopically assessed integrity of the EGJ was classified as one of three types, as follows:

• 1 Normal EGJ. The endoscope shaft was gripped tightly by the cardia in retroflexed endoscopy, or it was gripped less tightly but the cardia was seen to open and close with respiration.
• 2 Widened EGJ. The cardia was open during all phases of respiration in retroflexed endoscopy, but there was no endoscopic evidence of hiatal hernia (HH) on the antegrade view.
• 3 HH. The axial length from the EGJ to the diaphragmatic hiatus was at least 2 cm.

BE was found in 12 patients (1.2%). Normal EGJ was seen in 90.7% of patients, widened EGJ in 4.3%, and HH in 5%. Patients with widened EGJ had a significantly higher incidence of major reflux symptoms and erosive esophagitis compared with those with normal EGJ (P= 0.001). BE was found in 14% of patients with HH and in 0.5% of patients with a normal EGJ (P= 0.001). None of the patients with widened EGJ had BE. In terms of BE frequency, these patients did not differ significantly from those with normal EGJ (P= 0.793) but did differ significantly from those with HH (P= 0.014). The prevalence of BE was 1.2% in a Turkish population undergoing endoscopy for any reason. In terms of EGJ integrity, comparison of the groups showed that even in the absence of HH, patients with widening of the EGJ had an increased prevalence of major reflux symptoms and erosive esophagitis. However, histologically confirmed BE was not seen among patients with widened EGJ.     

福建地区Barrett食管的发病情况和内镜及临床特点

目的研究福建地区Barrett食管(BE)的发病情况和内镜、临床特点及其与反流性食管炎(RE)的关系。方法根据新标准诊断BE,研究BE患者的内镜下检出率、内镜表现、分型及病理检查结果,分析患者的年龄、性别、症状、幽门螺杆菌(Hp)感染情况及其与RE的关系。结果检出BE为总胃镜检查人数的7.90%,男女之比为1.98,平均年龄(45.1±14.8)岁,仅19.15%有典型反流症状。BE中短节段占81.20%,多为舌状、岛状或包含这2种形状的混合型。食管活检组织病理诊断为肠化型占BE的34.83%,9.88%伴异型增生,胃窦Hp阳性率为39.94%。RE检出率为2.07%,比BE显著降低(P<0.01)。8.42%的BE伴RE,32.11%的RE伴BE。结论福建地区BE患病率较高,多为短节段舌状或岛状,约1/3为肠化型,以中年男性多见,常无症状,与RE无明显相关性,部分伴异型增生。BE的临床意义和预后有待于进一步研究。     

DOES SHORT‐SEGMENT COLUMNAR‐LINED ESOPHAGUS ELONGATE DURING A MEAN FOLLOW‐UP PERIOD OF 5.7 YEARS?

Background: The length of Barrett's esophagus is considered to be important because it is associated with the risk of neoplasia. In Japan, there is a high prevalence of short‐segment columnar‐lined esophagus (SS‐CLE). The natural history of SS‐CLE is not fully understood, so the aim of the present study was to investigate the chronological changes of SS‐CLE. Methods: The subjects were 500 consecutive patients with SS‐CLE (327 men and 173 women; mean age: 64.0 years) diagnosed between January 2001 and July 2002 at our hospital based on the definition of SS‐CLE proposed by the Japanese Society for Esophageal Diseases. Follow‐up endoscopy was carried out annually for a mean period of 5.7 ± 1.2 years. The cumulative probability of SS‐CLE showing elongation was estimated by the Kaplan–Meier method, and factors related to endoscopic findings making an independent contribution to elongation were determined with Cox's proportional hazard model. Results: Elongation of SS‐CLE occurred in 29 patients (5.8%) during the follow‐up period and the cumulative 5‐year probability of elongation was 16.6%. There was no progression of SS‐CLE to Barrett's adenocarcinoma. The absence of atrophic gastritis (adjusted odds ratio (aOR): 23.4; 95%CI [6.5, 83.8]), the presence of reflux esophagitis (aOR: 4.53; 95%CI [1.2, 16.4]), and the flame‐shaped type of SS‐CLE (aOR: 22.4; 95%CI [7.8, 64.0]) were found to be independent contributors to the elongation of SS‐CLE. Conclusions: The present study demonstrated that SS‐CLE remains stable in length over time, especially in patients without atrophic gastritis, as well as in those with reflux esophagitis and/or flame‐shaped SS‐CLE at initial examination.     

老年人反流性食管炎及Barrett食管的发病情况和内镜临床特点

目的 研究老年人反流性食管炎(RE)及Barrett食管(BE)的发病情况、内镜临床特点及相互关系.方法 根据中国反流性食管病(炎)试行方案诊断RE,根据BE共识(2005重庆)诊断BE,研究老年人中RE及BE患者的内镜下检出率、内镜表现、分型,分析患者的性别、幽门螺杆菌(Hp)感染情况及RE与BE的关系.结果 老年人行胃镜检查的患者中RE检出率为3.18%,BE检出率为9.12%,前者显著较低(P＜0.01),男女之比分别为2.72、1.95,有典型反流症状者分别占45.21%、36.12%.RE中90.16%为轻中度(Ⅰ、Ⅱ级),BE中短段者占83.38%,多为舌状、岛状或包含这2种形状的混合型.活检病理检查发现伴不典型增生者RE中为18.52%、BE中为20.80%,多为轻中度.胃窦Hp阳性率RE患者为39.13%,BE患者为37.94%.7.70%的BE伴RE.结论 老年人RE及BE患病率均较高,男性均多见,RE多为轻中度,BE多为短节段舌状或岛状,近半数患者无典型反流症状,RE与BE相关性不明显.老年人RE及BE的高检出率值得重视.     

Time trends of endoscopic and pathological diagnoses related to gastroesophageal reflux disease in a Chinese population: eight years single institution experience

The discrepancy between Eastern and Western countries exists regarding the time trends of Barrett's esophagus (BE)/adenocarcinoma. We aimed to elucidate this issue through a retrospective review of the endoscopic and pathological diagnoses of gastroesophageal reflux disease (GERD) over time in a Chinese population. All records were analyzed from 2000 to 2007. Records included demographic data, clinical indication for endoscopy, and endoscopic findings. The total number of endoscopic procedures increased over time. The indications for referral endoscopy secondary to GERD increased from 366 cases (4.9%) in the beginning of the study to 1439 cases (14.1%) at the end. Concomitant GERD symptoms did not significantly change (range, 13–15.1%) in screening endoscopic studies. Endoscopic detection of erosive esophagitis increased in referral populations from 1546 (20.7%) to 5207 cases (51%) and by screening endoscopy from 791 (14.5%) to 1983 cases (23.5%). The prevalence of nonerosive reflux disease and BE did not change over time. BE‐associated dysplasia and adenocarcinoma were rare. The detection of Los Angeles class A disease increased with time in referral endoscopy cases with a focus on erosive esophagitis composition. The endoscopic demand for GERD investigation and the GERD endoscopic diagnosis increased in our population. The results were related to a higher prevalence of low‐grade erosive disease diagnosed. The incidence of BE‐associated dysplasia and adenocarcinoma has been the same and the increased screening did not detect more cancers.     

Barrett's esophagus-related diseases remain uncommon in China

Barrett's esophagus (BE)-related esophageal adenocarcinoma (EAC) has shown the fastest rise in incidence in Western countries; however, research data on BE-related diseases from China are inconclusive. We aimed to review and analyze the published results on these diseases in China. We searched PubMed and Chinese medical literature for key words: BE, EAC, Chinese and China. Relevant research papers along with the study results from our own groups were reviewed and analyzed. Using standardized criteria, columnar-lined esophagus (CLE) was found in as many as 29% of resection specimens in Chinese patients with proximal gastric cancer. However, BE with intestinal metaplasia was rare, ranging from 0.06% in the general population to <2% in referral patients. Risk factors included advancing age, hiatal hernia and probably gastroesophageal reflux disease and tobacco or alcohol abuse, but not male gender or obesity. At endoscopy, most CLE/BE were <2 cm in length, and appeared tongue-like and island-like. The long-segment BE was rare, especially in women. Population-based studies conducted in Taiwan and Hong Kong SAR, China showed that EAC was not only rare but also stable or had decreased in incidence over the past decade. By histopathology, EAC accounted for only 1% of all distal esophageal cancers and almost all gastroesophageal junction (GEJ) cancers were centered in the proximal stomach. BE-related diseases, except for CLE, are rare in China. The clinical significance and malignant potential of CLE in the Chinese population remain elusive. Further investigation on these diseases is in progress.     

Prevalence of Barrett’s Esophagus Remains Low in the Korean Population: Nationwide Cross-Sectional Prospective Multicenter Study

Purpose

In contrast to the Western population, the prevalence of Barrett’s esophagus (BE) is rare in the Korean population. However, the recent increase in prevalence of gastroesophageal reflux disease (GERD) may affect the prevalence of BE. The aim of this study was to survey the prevalence of BE and evaluate its risk factors.

Methods

Patients between 18 and 75 years of age who visited 11 Korean tertiary referral centers between April and July 2006 for routine upper endoscopic examination were surveyed using a symptom questionnaire. Biopsies were performed on the columnar lined epithelium (CLE) of the distal esophagus, and diagnosis was confirmed with detection of specialized intestinal metaplasia.

Results

The study comprised 2,048 patients (mean age 51.4 years, 965 males). The frequency of heartburn or acid regurgitation was 8.7% and 13.1%, respectively. Reflux esophagitis was diagnosed in 10.1% of patients (207 patients); however, most patients had mild reflux. CLE was found in 82 patients; however, only one patient had long-segment CLE. The prevalence of BE was 1% (21 patients). The risk factors for BE were age (P = 0.006), presence of heartburn [odds ratio (OR) 4.33, 95% confidence interval (CI) 1.66–11.34, P = 0.007], acid regurgitation (OR 3.37, 95% CI 1.35–8.42, P = 0.01), sliding hernia (OR 6.21, 95% CI 1.78–21.72, P = 0.001), and reflux esophagitis (OR 10.28, 95% CI 4.31–24.50, P < 0.0001) on univariate analysis. On multivariate analysis, presence of typical reflux symptoms (P = 0.02) and reflux esophagitis (P < 0.001) were significant.

Conclusions

Prevalence of Barrett’s esophagus remains low in Koreans; however, risk of developing BE has increased in patients with GERD symptoms and reflux esophagitis.     

食管癌高发区Barrett食管检出率和P_(53)的表达

了解食管癌高发区Ｂａｒｒｅｔｔ＇ｓ食管（ＢＥ）的患病率及ＢＥ与食管腺癌的关系。对３３１例河南省食管癌高发区农村自然人群进行了Ｂａｒｒｅｔ＇ｓ食管的内镜普查和病理组织学检查。同时对１４例来自门诊的Ｂａｒｒｅｔｔ＇ｓ食管病人的活检标本，用免疫组织化学染色的方法检测了抗癌基因Ｐ５３的表达。结果显示：该人群Ｅａｒｒｅｔｔ＇ｓ食管患病率为０．９１％，返流性食管炎的检出率为７．６％。抗癌基因Ｐ５３在１４例Ｂａｒｒｅｔｔ＇ｓ食管标本中阳性表达率为４２％。其中５０％阳性表达的标本伴有不典型增生。Ｐ５３阳性表达可能是Ｂａｒｒｅｔｔ＇ｓ食管上皮到食管腺癌发生过程中一个极早期的改变。对Ｂａｒｒｅｔｔ＇ｓ食管伴有不典型增生或肿瘤基因表达阳性者应视为高危人群，对他们进行重点预防和阻断治疗是必要的。     

Detection of Barrett's esophagus after endoscopic healing of erosive esophagitis

BACKGROUND: The presence of erosive esophagitis (EE) in patients presenting for upper endoscopy may prevent the detection of underlying Barrett's esophagus (BE) in the distal esophagus. AIM: To prospectively determine the proportion of patients detected with BE upon repeat endoscopy after healing of EE. METHODS: Patients with endoscopically confirmed EE without BE were treated with standard doses of acid suppression therapy and a repeat endoscopy was performed to assess the presence of BE. If columnar mucosa was visualized in the distal esophagus, targeted biopsies were obtained and all biopsies were evaluated for the presence of intestinal metaplasia. BE was defined as columnar mucosa in the distal esophagus with intestinal metaplasia on biopsy. RESULTS: A total of 172 patients with reflux symptoms were diagnosed with EE without BE on initial endoscopy. They were treated with standard doses of proton pump inhibitor therapy, and after a mean duration of 11 wk (range 8-16 wk), a repeat endoscopy was performed to confirm healing of EE and to document the presence of BE. On repeat endoscopy, EE was completely healed in 116 patients (67%), and of those, BE was suspected in 32 patients (i.e., columnar-lined distal esophagus) and was confirmed in 16 patients (13.8%). In the 56 patients with persistent EE on repeat endoscopy, columnar mucosa in areas of previously healed esophagitis was visualized in 8 and confirmed in 5 patients (8.9% of nonhealed cases). Overall, 21 (12%) patients were confirmed with BE on repeat endoscopy; all men, mean age 61 yr with a median BE length of 0.5 cm (range 0.5-5 cm, interquartile range 0.5 cm). The majority of these patients (N = 19) had short segment Barrett's esophagus (SSBE) (i.e., length <3 cm). CONCLUSIONS: In patients with EE undergoing treatment with acid suppressive therapy, BE (mainly SSBE) is detected in approximately 12% of patients on repeat endoscopy. Patients with reflux symptoms undergoing endoscopy for the detection of BE (i.e., screening) should be treated with acid suppressive therapy prior to endoscopy to enhance the yield of BE. Alternatively, if the goal is to document BE and if EE is found at the initial endoscopy, then repeat endoscopy may be considered after acid suppressive therapy.     

反流性食管炎、Barrett食管的食管动力学研究

目的 探讨反流性食管炎(RE)、Barrett食管(BE)的动力学改变。方法 经内镜检查3 400例患者,分 RE、BE、对照组,进行症状调查、食管测压、食管24h pH检测,并行统计学分析。结果 RE与BE组间除吞咽不适外,烧心感、反酸及胸骨后疼痛的症状评分均为RE组大于BE组,且差异有显著性意义。部分RE、BE、对照组间食管运动功能比较,食管下括约肌静息压等差异均无显著性意义。食管24 h pH检测DeMeester评分、pH<4总时间、pH<4时间的百分比等 RE、BE组高于对照组,差异有显著性意义,但RE、BE组间差别无显著性意义。结论 食管反流症状与食管黏膜的内镜下表现不一致;食管组织化生与食管运动功能间无相关。     

Prevalence of Barrett’s Esophagus in Patients with or without GERD Symptoms: Role of Race, Age, and Gender

Background Gastroesophageal reflux disease is associated with a significantly increased risk of Barrett’s esophagus (BE) and adenocarcinoma of the esophagus. Racial differences in the prevalence of BE are controversial. Our purpose was to study the prevalence of Barrett’s esophagus in patients with and without gastroesophageal reflux disease (GERD) symptoms, and the differences between these two groups in terms of race, age, and sex. Methods Esophagogastroduodenoscopy (EGD) reports from the PENTAX EndoPRO database for the Endoscopy Unit at the University of Texas Medical Branch from 2005 to 2007 were reviewed. Four hundred and ten patients who underwent upper endoscopy because of GERD symptoms that were not responding to proton pump inhibitor (PPI) therapy or with alarm symptoms and 4,047 patients undergoing upper endoscopy for other reasons without GERD symptoms were identified. Results BE was significantly more common among males. The prevalence of BE was higher in patients with GERD symptoms than those without GERD symptoms. Overall, more cases of BE, dysplasia, and adenocarcinoma were found among the patients without GERD symptoms than those that underwent endoscopy because of GERD symptoms. The prevalence of BE among Caucasian, African American, Hispanic, and “other” groups with GERD symptoms were 5%, 2.56%, 4.4%, and 0%, respectively. The prevalence of BE among these racial groups without GERD symptoms were 1.9%, 0.9%, 1.57%, and 0.8%, respectively. The association between race and BE was not statistically significant (df = 3, P = 0.2628), including after adjusting for the presence of GERD symptoms (df = 3, P = 0.2947). Patients without GERD symptoms that presented with BE were significantly older than the patients without BE (P < 0.01). Conclusions BE is a male-dominant disease. The prevalence of Barrett’s esophagus was not significant different among Caucasian, Hispanics, and African Americans. Most of the patients with BE, dysplasia, and adenocarcinoma did not have GERD symptoms. X. Fan contributed to the concept and design of the study, the analysis and interpretation of the data, and the drafting of this article. N. Snyder contributed to the critical revision of the article for important intellectual content and final approval of this article.     

The Prevalence of Barrett's Esophagus and Erosive Esophagitis in Patients Undergoing Upper Endoscopy for Dyspepsia in a VA Population

The purpose of this study was to establish the prevalence of Barrett's esophagus and erosive esophagitis in a group of patients undergoing upper endoscopy for dyspepsia. Computerized endoscopy records were retrospectively evaluated to identify patients who underwent upper endoscopy for dyspepsia. Objective findings were recorded, including the presence of Barrett's esophagus, erosive esophagitis, and peptic ulcer disease. Among 264 patients, Barrett's esophagus was found in 16 (6.1%). The mean length of Barrett's was 2.0 cm, and the majority (81.3%) was short segment. Erosive esophagitis was found in 62 patients (23.%), and peptic ulcer disease was found in 25 patients (9.5%). Approximately 30% of patients undergoing endoscopy for dyspepsia had esophageal lesions. The prevalence of Barrett's in this population was 6%. Based on these results, a trial of acid suppression may benefit a third of patients with dyspepsia. Current screening practices for Barrett's in reflux patients alone may need to be reevaluated.     

数字染色内镜及共聚焦激光显微内镜在Barrett食管诊断中的价值研究

目的探讨数字染色内镜（I-Scan）及共聚焦激光显微内镜（CLE）对Barrett食管（BE）的诊断价值。方法878例患者行普通内镜和I-Scan模式下检查，部分筛查出的疑似BE患者行CLE检查及活检，比较普通内镜和I-Scan模式下疑似BE检出率及图象特点，对比分析活检病理及CLE诊断BE结果。结果普通胃镜模式下筛查出疑似BE患者46例（5．2％），I-Scan筛查出52例（5．9％），两者比较差异无统计学意义（x2=0．533，P〉0．05）；普通胃镜模式下SCJ与CEJ间距间可观察到栅栏状血管者21例（45．7％），I-Scan可观察到35例（67．3％），两者比较差异有统计学意义（X2=0．031，P〈0．05）。19例疑似BE患者进行了CLE检查及活检，CLE诊断BE的敏感度、特异度分别为93％和100％。结论I-Scan对SCJ与GEJ间距间栅栏状血管的观察具有重要意义，可提高疑似BE检出率；CLE使实时在体组织学诊断成为可能，诊断BE的敏感度和特异度均较高。     

The perception of cancer risk in patients with prevalent Barrett's esophagus enrolled in an endoscopic surveillance program

BACKGROUND & AIMS: Patients with Barrett's esophagus (BE) have a risk of esophageal adenocarcinoma of approximately 0.5% per year. Patients may have difficulty understanding this risk. This study assessed the perceived risk of cancer in patients with BE, and correlated their risk estimates with their health care use behaviors. METHODS: We performed a survey of patients with BE participating in an endoscopic surveillance program at 2 sites: a university teaching hospital and a Veterans' Administration hospital. A questionnaire also elicited their demographics as well as their sources of health information. Health care behaviors, including physician visits and endoscopic surveillance behaviors, were assessed. Patients were classified as either overestimators or nonoverestimators of risk. Characteristics of overestimators, as well as health care use patterns, were assessed. RESULTS: One hundred eighteen patients met entry criteria, and 92 (78%) completed all the questionnaires. Sixty-eight percent of patients overestimated their 1-year risk of cancer, with a mean estimated 1-year cancer risk being 13.6%. The lifetime risk also was overestimated by 38% of patients. Patients who overestimated risk were more likely to be Veterans' Administration medical center patients, have more symptomatic reflux, and were more likely to use the Internet to get health care information. There was no significant difference in physician visits between overestimators and nonestimators (1.2 visits per year vs 1.0, P = .20), nor in endoscopy use (5.7 endoscopies per 5-year period vs 5.0, P = .42). CONCLUSIONS: The majority of patients with prevalent BE participating in an endoscopic surveillance program overestimated their chances of developing adenocarcinoma of the esophagus. Efforts to improve education of such patients with BE are warranted.     

Ethnic Differences in the Prevalence of Endoscopic Esophagitis and Barrett's Esophagus: The Long and Short of It All

Recent studies indicate that the prevalence of gastroesophageal reflux disease in Asia is either increasing or better recognized. There is a paucity of reliable data on the prevalence of reflux disease in the various races in general and in Malaysia, in particular. The prevalence of erosive esophagitis and Barrett's esophagus in a multiethnic Malaysian population was studied, as well as the relationship of various factors associated with reflux disease. Chinese, Malay, and Indian patients undergoing gastroscopy in a tertiary referral center were assessed for the presence of esophagitis, hiatus hernia, and Barrett's esophagus. Patient demographics and risk factors associated with gastroesophageal reflux disease were also documented. The prevalence of endoscopically documented esophagitis among 1985 patients was 6.1%, the majority of which were mild, Grade I or II (88%). There was a preponderance of Indians with esophagitis, as well as males (P<0.05) and those with the presence of a hiatus hernia (P<0.01). Long-segment Barrett's esophagus was found in 1.6% of patients, and short-segment Barrett's in 4.6%. Indians had the highest prevalence of Barrett's esophagus compared with Chinese (P<0.05) or Malays (P<0.01). Hiatus hernia and erosive esophagitis were both positively associated with Barrett's metaplasia (P<0.01). A significant proportion of Malaysian patients undergoing endoscopy has mild reflux esophagitis and Barrett's esophagus. Indian ethnicity and the presence of a hiatus hernia were significantly associated with endoscopic esophagitis and Barrett's metaplasia. These observed racial differences warrant further study.