GERD symptoms predict long but not short segment BE
MedWire News: Gastroesophageal reflux disease (GERD) symptoms significantly predict long, but not short, segment Barrett’s esophagus (BE), show results from a systematic review and meta-analysis.
Screening for BE mostly relies on identification of patients with GERD symptoms, but the link between BE and GERD has largely been assumed rather than proven. In some recent studies a high proportion of patients with BE did not have GERD symptoms.
Writing in the American Journal of Gastroenterology, Joel Rubenstein (Veterans Affairs Medical Center, Ann Arbor, Michigan, USA) and co-workers report the results of a systematic review and meta-analysis of 26 studies carried out to investigate the association between BE and GERD symptoms.
To be included, studies had to have BE diagnosed from suspicion on endoscopy and confirmed by histological findings of intestinal metaplasia, while symptoms of GERD were confirmed by interview or questionnaire. The studies also had to include patients with and without BE and with and without GERD.
‘High quality’ sampling studies (n=6) were defined as those in which cases and controls were identified among unselected research volunteers, compared with those where patients were selected for endoscopy based on clinical indications (n=14), a method that may introduce selection and ascertainment bias. Six studies were intermediate, as cases were selected based on clinical indications and controls randomly.
The team found that overall patients with GERD were 2.90 times more likely to have BE than those without GERD.
When patients were stratified by whether they had short or long segment BE and by sampling design, Rubenstein and co-authors found that in poorer quality clinical design studies GERD patients had a 2.38-fold increased risk for short segment BE, but a stronger 2.96-fold increased risk for long segment BE.
In high quality sampling research design studies, the corresponding values associated with presence of GERD were increased 1.15 and 4.92 fold. However, the association with short segment BE was nonsignificant.
“Current screening efforts for esophageal adenocarcinoma are focused on patients with GERD symptoms,” say the authors. “However, our study shows that such efforts largely miss patients with short segment BE.”
“If short segment BE is considered worthy of identification, then current screening practices do not select patients at risk for endoscopy, and alternative methods of selection for screening need to be developed,” they conclude.
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By Helen Albert