Elsevier

Gastrointestinal Endoscopy

Volume 70, Issue 5, November 2009, Pages 867-873
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
Screening for Barrett's esophagus in asymptomatic women

https://doi.org/10.1016/j.gie.2009.04.053Get rights and content

Background

Barrett's esophagus (BE) has been detected in approximately 10% of patients with chronic GERD. Previous studies demonstrated a similar prevalence of BE in asymptomatic adults.

Objective

To determine the prevalence of BE in asymptomatic women.

Design

We invited women scheduled for routine screening colonoscopy (for colorectal cancer) and women undergoing endoscopic examination before bariatric surgery to participate. Patients experiencing heartburn symptoms more than once per month were excluded.

Setting

Outpatients at Stanford University and Palo Alto VA Health Care System.

Interventions

Biopsies of the esophagogastric junction in the setting of suspected BE, and completion of symptom and health-related quality of life questionnaires to ensure that subjects were asymptomatic.

Main Outcome Measurement

Identification of BE.

Results

We detected BE in 8 (6%) of 126 subjects, including 3 (5%) of 61 of the women in the colorectal cancer screening cohort and 5 (8%) of 65 of the women in the pre–bariatric surgery cohort, all of whom had BE measuring 2 cm or less (P = .30). Patients found to have BE were more likely to be older (mean age 60 years vs 49 years, respectively; P = .04), but there was no difference in mean body mass index, ethnicity, or tobacco or alcohol use between patients with and without BE. BE was only present in pre–bariatric surgery subjects younger than the age of 50 and was most common in the 61- to 70-year age cohort in both groups. Erosive esophagitis, microscopic reflux changes, and Helicobacter pylori infection were not more common in the pre–bariatric surgery group.

Limitation

Small number of subjects with BE detected.

Conclusions

Short-segment BE was detected in 6% of asymptomatic women undergoing screening endoscopic examinations.

Section snippets

Methods

Approval was obtained from the Human Subjects Panel at Stanford University and the VA Palo Alto Health Care System for this study. During the first phase of the project, women undergoing routine screening colonoscopy were invited to undergo upper endoscopy directly following the colonoscopy. Funding for the upper endoscopic examinations was obtained by Dr. Gerson via the Estelle Buel Simon Fund at Stanford University. Potential candidates were sent a letter of invitation and were required to

Results

We invited 252 patients to participate in the study. A flow diagram detailing the subjects' progression through the study is shown in Figure 1. Seventeen (7%) patients refused to participate (all patients refusing were in the screening colonoscopy cohort) and 31 (12%) were excluded because of daily or weekly GERD symptoms (13 from the screening colonoscopy cohort and 18 from the pre–bariatric surgery group). One hundred twenty-six patients (50%) agreed to participate, including 61 patients

Discussion

BE is a metaplastic alteration of the distal esophageal epithelium to specialized intestinal epithelium and is thought to arise after injury of the squamous epithelium with repair occurring via a more acid-tolerant columnar epithelium. Canine models have supported the concept of mucosal injury leading to tissue regeneration via metaplastic columnar epithelium.16 In most cases, injury to the squamous epithelium occurs because of acid reflux disease, a common disorder occurring in approximately

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  • Cited by (0)

    DISCLOSURE: The following author disclosed financial relationships relevant to this publication: L. B. Gerson: speaker for AstraZeneca, Takeda Pharmaceuticals, and Santarus. Supported by a grant from the Estelle Buel Simon Fund at Stanford University and an American Gastroenterological Association Research Scholar Award to L. B. Gerson. The other author disclosed no financial relationships relevant to this publication.

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