Document Detail


Gastroesophageal reflux disease symptom severity, proton pump inhibitor use, and esophageal carcinogenesis.
MedLine Citation:
PMID:  21768433     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
HYPOTHESIS: Screening for esophageal adenocarcinoma has focused on identifying Barrett esophagus (BE) in patients with severe, long-standing symptoms of gastroesophageal reflux disease (GERD). Unfortunately, 95% of patients who develop esophageal adenocarcinoma are unaware of the presence of BE before their cancer diagnosis, which means they never had been selected for screening. One possible explanation is that no correlation exists between the severity of GERD symptoms and cancer risk. We hypothesize that severe GERD symptoms are not associated with an increase in the prevalence of BE, dysplasia, or cancer in patients undergoing primary endoscopic screening.
DESIGN: Cross-sectional study.
SETTING: University hospital.
PATIENTS: A total of 769 patients with GERD.
INTERVENTIONS: Primary screening endoscopy performed from November 1, 2004, through June 7, 2007.
MAIN OUTCOMES MEASURES: Symptom severity, proton pump inhibitor therapy, and esophageal adenocarcinogenesis (ie, BE, dysplasia, or cancer).
RESULTS: Endoscopy revealed adenocarcinogenesis in 122 patients. An increasing number of severe GERD symptoms correlated positively with endoscopic findings of esophagitis (odds ratio, 1.05; 95% confidence interval, 1.01-1.09). Conversely, an increasing number of severe GERD symptoms were associated with decreased odds of adenocarcinogenesis (odds ratio, 0.94; 95% confidence interval, 0.89-0.98). Patients taking proton pump inhibitors were 61.3% and 81.5% more likely to have adenocarcinogenesis if they reported no severe typical or atypical GERD symptoms, respectively, compared with patients taking proton pump inhibitors, who reported that all symptoms were severe.
CONCLUSIONS: Medically treated patients with mild or absent GERD symptoms have significantly higher odds of adenocarcinogenesis compared with medically treated patients with severe GERD symptoms. This finding may explain the failure of the current screening paradigm in which the threshold for primary endoscopic examination is based on symptom severity.
Authors:
Katie S Nason; Promporn Paula Wichienkuer; Omar Awais; Matthew J Schuchert; James D Luketich; Robert W O'Rourke; John G Hunter; Cynthia D Morris; Blair A Jobe
Related Documents :
7854543 - Myasthenia gravis during interferon alfa therapy.
6198843 - Treatment of cutaneous t-cell lymphomas with tp-5. evaluation of the clinical effect in...
6787583 - Effects of prolactin suppression on hypogonadism im patients on maintenance haemodialysis.
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of surgery (Chicago, Ill. : 1960)     Volume:  146     ISSN:  1538-3644     ISO Abbreviation:  Arch Surg     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-19     Completed Date:  2011-10-19     Revised Date:  2014-07-09    
Medline Journal Info:
Nlm Unique ID:  9716528     Medline TA:  Arch Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  851-8     Citation Subset:  AIM; IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Barrett Esophagus / diagnosis,  epidemiology,  etiology*
Cross-Sectional Studies
Disease Progression
Endoscopy, Gastrointestinal
Esophageal Neoplasms / diagnosis,  epidemiology,  etiology*
Female
Gastroesophageal Reflux / complications,  diagnosis*,  drug therapy
Humans
Male
Middle Aged
Oregon / epidemiology
Prevalence
Proton Pump Inhibitors / therapeutic use*
Questionnaires
Retrospective Studies
Risk Factors
Severity of Illness Index
Grant Support
ID/Acronym/Agency:
K08 DK074397/DK/NIDDK NIH HHS; K23 DK066165/DK/NIDDK NIH HHS; K23 DK066165-01/DK/NIDDK NIH HHS; R21 DK081161/DK/NIDDK NIH HHS; R21 DK081161/DK/NIDDK NIH HHS; U01 DK57132/DK/NIDDK NIH HHS; UL1 RR024140/RR/NCRR NIH HHS
Chemical
Reg. No./Substance:
0/Proton Pump Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Totally robotic right hepatectomy: surgical technique and outcomes.
Next Document:  Experience with laparoscopic donor nephrectomy among more than 1000 cases: low complication rates, d...