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Predictors of columnar lined esophagus in GERD

A study in November's issue of the American Journal of Gastroenterology investigates the prevalence and predictors of columnar lined esophagus in GERD patients undergoing upper endoscopy.

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Chronic gastroesophageal reflux disease (GERD) is a risk factor for Barrett's esophagus, the most important surrogate marker for the development of esophageal adenocarcinoma.

The need to document the presence of intestinal metaplasia in esophageal biopsies from a columnar lined esophagus to diagnose Barrett's esophagus is debated.

Dr Prateek Sharma and colleagues from Missouri, USA prospectively evaluated the prevalence and risk factors of columnar lined esophagus in a large cohort of GERD patients undergoing upper endoscopy.

Consecutive patients presenting to the endoscopy unit at a tertiary referral center for their index upper endoscopy for evaluation of GERD symptoms were enrolled in this prospective cohort study.

Patients were asked to complete a validated GERD questionnaire that documents the onset of GERD symptoms, and grades the frequency and severity of symptoms experienced over the past year.

The prevalence of columnar lined esophagus was 23%
American Journal of Gastroenterology

Demographic information, body mass index, and use of aspirin/nonsteroidal antiinflammatory drugs were recorded.

The team evaluated endoscopic details including length of columnar lined esophagus, presence and size of hiatal hernia.

All factors that were statistically significant were then entered into stepwise logistic regression to evaluate for independent predictors of columnar lined esophagus.

The research team enrolled a total of 1058 patients with GERD symptoms.

On index endoscopy, the team found that the prevalence of columnar lined esophagus was 23%, whereas of columnar lined esophagus with documented intestinal metaplasia was 14%.

The research team observed that male gender, Caucasian race, heartburn duration of more than 5 years, presence and size of hiatal hernia were significantly associated with the presence of CLE compared with controls.

On further analysis, the team noted that heartburn duration more than 5 years, Caucasian race, and hiatal hernia were independent predictors for columnar lined esophagus.

The team found that columnar lined esophagus length was significantly associated with the presence of intestinal metaplasia.
 
Dr Sharma's team concludes, "If Barrett's esophagus is defined by the presence of columnar lined esophagus alone on upper endoscopy, up to 25% of GERD patients are diagnosed with this lesion."

"Enrolling all these patients in surveillance programs would have significant ramifications on health-care resources."

Am J Gastroenterol 2012; 107:1655–1661
23 November 2012

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