Document Detail

Gastroesophageal reflux disease symptom severity, proton pump inhibitor use, and esophageal carcinogenesis.
MedLine Citation:
PMID:  21768433     Owner:  NLM     Status:  In-Data-Review    
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.
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
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Publication Detail:
Type:  Journal Article    
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:  -     Revised Date:  -    
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    
Division of Thoracic and Foregut Surgery, Universty of Pittsburgh, Shadyside Medical Building, 5200 Centre Ave, Ste 715, Pittsburgh, PA 15232.
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