In this study, published in the October issue of the American Journal of Gastroenterology, researchers examined the prevalence of GERD-related endoscopic findings according to the volume of referrals.
The team gathered data on all GERD patients who underwent an upper GI endoscopy by general practitioners (GPs) during 1 year.
The study population consisted of 3378 patients, with a mean age of 58.1 years and a male:female ratio of 1:1.3. The hospital referral area population was 260,000.
|Endoscopy positive GERD|
- high referral volume = 22%
- low referral volume = 15%
|American Journal of Gastroenterology|
The team documented the number of referrals to endoscopy in health care units, and the number of endoscopy positive GERD, BE, and esophageal neoplasms.
However, patients with symptoms or signs suggesting acute upper GI bleeding and those attending follow-up endoscopy were excluded.
Also excluded, were patients who had had previous esophagogastric surgery or Helicobacter pylori eradication therapy.
The team discovered, that of the 760 patients who underwent endoscopy because of heartburn or regurgitation, 33% had endoscopy positive (erosive) GERD.
11 had BE (1 with esophageal adenocarcinoma), 6 esophageal ulcer, and 1 peptic esophageal stricture.
Between health care units, the referrals to endoscopy varied from 0.6 to 9.2/1000 inhabitants per year.
The team found that in health care units with high referral volumes (greater than or equal 3.3/1000/year) endoscopy positive GERD was 22%, while esophageal ulcer was 1%, esophageal stricture 0.4%, BE 0.6%, and esophageal neoplasm 0.2%
In units with low referral volumes (less than 3.3/1000/year) values were 15%, 0.7%, 0.3%, 0.8%, and 0.3%, respectively.
Multivariate analyses showed that independent risk factors for endoscopy positive GERD were male sex (odds ratio, 1.4), GERD symptoms (3.3), dysphagia (1.4), and living in a high referral area (1.4).
Independent risk factors for BE were male sex (odds ratio, 2.6) and GERD symptoms (2.9), whereas the only independent risk factor for esophageal neoplasm was dysphagia (40).
Dr Timo Mäntynen's research team concluded, "There is a wide variation in GPs' referrals for endoscopy".
"Increasing the referral volume significantly increases the proportion of endoscopy positive GERD cases, but not that of GERD complications such as BE, esophageal ulcer, peptic stricture, or esophageal neoplasms".