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Barrett’s esophagus (BE) is a major risk factor esophageal adenocarcinoma (EAC), the incidence of which is on the rise in Western countries. Current guidelines from multiple national societies recommend screening for BE among patients with multiple risk factors. Data on screening practices for patients with multiple risk factors have been be clearly reported. We aimed to assess the adherence to national guidelines regarding screening patients with BE risk factors by assessing the rates of endoscopy in patients with 3 or more BE risk factors.
This analysis was conducted using electronic health record (EHR) data from the OneFlorida Clinical Data Research Network – a statewide network of health care systems that provide medical care to more than 40% of Floridians. Using ICD-9/10 codes, we identified patients with GERD plus at least two other risk factors for BE or EAC. Risk factors included male sex, advanced age (>50 year), white race, obesity (BMI >30), and smoking status. The primary outcome of interest was the proportion of patient with at least 3 identifiable risk factors for BE who had endoscopy. The indication for the endoscopy did not have to be screening or GERD. Rather, endoscopy for any indication was considered adequate for screening. We used Chi-square tests examine gender differences. We reported odd ratios (OR), 95% confidence intervals (CI), and p-values.
Our database included a total of 9,459,363 patients, including 3,975,760 males and 5,483,603 females. The overall prevalence of GERD was 10.8% (n= 1,017,588). Rates of EGD for all indications were low. Figure 1 shows the rate of endoscopy in 6 risk categories of patients with three or more risk factors for BE. Endoscopy rates were lowest in males with GERD + advanced age + obesity at 19.6%. The rates were highest in patients with GERD, white race, advanced age, obese, and smoker at 29.2%. Overall, females were more likely to have EGD at any of the risk categories.