Age- and sex-specific yield of Barrett's esophagus by endoscopy indication
Received 12 February 2009; accepted 25 June 2009. published online 14 September 2009.
Background
Barrett's esophagus is a precursor of esophageal adenocarcinoma, both of which are associated with GERD. Screening GERD patients for Barrett's esophagus has been suggested, but it is not known which patients should be screened and at what age.
Objective
To determine the age-specific yield of endoscopy for Barrett's esophagus stratified by sex and indication for endoscopy.
Design
Retrospective cross-sectional study.
Setting
National Endoscopic Database of the Clinical Outcomes Research Initiative (CORI).
Patients
A total of 155,641 patients undergoing their first endoscopy at one of the CORI sites for clinical indications.
Main Outcome Measurements
Age-specific yield of Barrett's esophagus.
Results
Among white men with GERD, the yield of Barrett's esophagus increases steeply from early adulthood (2.1% in the third decade of life) to middle adulthood (9.3% in the sixth decade) and then plateaus (the difference for the eighth decade minus the sixth decade is −1.1%; 95% CI, −3.9% to 1.7%). There is no difference in the yield of Barrett's esophagus between middle-aged white women with GERD and white men without GERD (difference is −0.46%; 95% CI, −1.23% to 0.31%).
Limitations
Possible bias by selection for endoscopy and the potential for misclassification of GERD status.
Conclusions
The yield of upper endoscopy for the diagnosis of Barrett's esophagus increases rapidly among white men with GERD until approximately age 50 and then reaches a plateau. White women with GERD are at no increased risk compared with white men without GERD.
Current affiliations: Veterans Affairs Center for Clinical Management Research (J.H.R.), Ann Arbor, Michigan, Division of Gastroenterology (J.H.R.), University of Michigan Medical School, Ann Arbor, Michigan, Division of Gastroenterology (N.M., G.E.), Oregon Health & Science University, Portland, Oregon, USA
Reprint requests: Joel H. Rubenstein, MD, MSc, VA Medical Center 111-D, 2215 Fuller Road, Ann Arbor, MI 48105.
DISCLOSURE: The following authors received research support for this study: G. Eisen: Executive Codirector of CORI, a nonprofit organization that receives funding from federal and industry sources; CORI has received support from the following entities to support the infrastructure of the practice-based network: AstraZeneca, Bard International, Pentax USA, ProVation, Endosoft, GIVEN Imaging, and Ethicon. The commercial entities had no involvement in this research. This potential conflict of interest has been reviewed and managed by the Oregon Health and Science University Conflict of Interest in Research Committee. All other authors disclosed no financial relationships relevant to this publication. This project was supported with funding from NIDDK UO1 CA 89389-01 and R33-DK61778-01. J.H.R. is the Damon Runyon-Gordon Family Clinical Investigator and is supported in part by the Damon Runyon Cancer Research Foundation (CI-36-07), and was supported by NIDDK 1K23DK079291.
If you would like to chat with an author of this article, you may contact Dr. Rubenstein at jhr@umich.edu.
ABSTRACT
Age- and sex-specific yield of Barrett's esophagus by endoscopy indication