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A Cross-sectional Analysis of the Prevalence of Barrett Esophagus in Otolaryngology Patients With Laryngeal Symptoms

Nason, Katie S. MD, MPH*; Murphy, Thomas MD*; Schindler, Joshua MD; Schipper, Paul H. MD; Hoppo, Toshitaka MD, PhD§; Diggs, Brian S. PhD; Sauer, David A. MD; Shaheen, Nicholas J. MD, MPH; Morris, Cynthia D. PhD, MPH#; Jobe, Blair A. MD, FACS§Barrett’s Esophagus Risk Consortium (BERC)

Journal of Clinical Gastroenterology: October 2013 - Volume 47 - Issue 9 - p 762–768
doi: 10.1097/MCG.0b013e318293d522
ALIMENTARY TRACT: Original Articles

Background: Populations at risk for esophageal adenocarcinoma remain poorly defined. Laryngeal symptoms can be secondary to laryngopharyngeal reflux (LPR) and can occur without associated gastroesophageal reflux symptoms such as heartburn and regurgitation.

Goal: We sought to determine the prevalence of Barrett esophagus (BE) in otolaryngology patients with laryngeal symptoms±typical gastroesophageal reflux disease (GERD) symptoms.

Study: We performed a cross-sectional study of otolaryngology clinic patients who reported laryngeal symptoms. Symptoms, medications, and exposure histories were obtained. Unsedated transnasal endoscopy was performed. Suspected BE was biopsied and confirmed histologically. Risk factors and prevalence of BE were assessed.

Results: Two hundred ninety-five patients were enrolled [73% male, median age 60 y (interquartile range 51 to 68 y)]. The overall prevalence of BE was 11.8% (n=33). Antisecretory medication use was present in 56% (n=156) of patients at enrollment. Compared with patients without BE, patients with BE were more likely to be male (P=0.01) and to report occupational lung injury (P=0.001). Duration, but not severity of laryngeal symptoms, significantly increased the odds of BE (odds ratio, 5.64; 95% confidence interval, 1.28-24.83; for a duration of symptoms >5 y). Of patients with BE, 58% (n=19) had coexisting LPR and GERD symptoms and 30% (n=10) had only LPR symptoms. Presence and size of hiatal hernia and length of columnar-lined esophagus were significant risk factors for BE.

Conclusions: Long-standing laryngeal symptoms are associated with the presence of BE in otolaryngology patients. Patients with chronic laryngeal symptoms and no identifiable ear, nose, or throat etiology for those symptoms may benefit from endoscopic screening regardless of whether typical GERD symptoms are present.

*Department of Cardiothoracic Surgery, Division of Thoracic and Foregut Surgery, University of Pittsburgh

§Department of Surgery, Western Pennsylvania Hospital, West Penn Allegheny Health System, Pittsburgh, PA

Departments of Otolaryngology

Surgery

Pathology

#Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR

Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC

K.S.N. and T.M. has shared first authorship.

Presented at the poster session of the American Gastroenterological Association/Digestive Disease Week, May 7-10, 2011, Chicago, IL.

Supported in-part by the David E. Gold and Irene Blumenkranz Esophageal Cancer Research Fund (B.A.J.), Michael J. Newton Esophageal Cancer Foundation (B.A.J.), Robert Anthony McHugh Research Fund for the Prevention and Early Detection of Esophageal Cancer (B.A.J.), and National Institutes of Health grants UL1 RR024140, UL1 RR024153, K23 DK066165-01 (B.A.J.), R21 DK081161-01 (B.A.J.), and U01 DK57132.

The authors declare that they have nothing to disclose.

Reprints: Blair A. Jobe, MD, FACS, Department of Surgery, Western Pennsylvania Hospital, West Penn Allegheny Health System, 4600 North Tower, 4800 Friendship Avenue, Pittsburgh, PA 15524 (e-mail: bjobe1@wpahs.org).

Received September 13, 2012

Accepted March 25, 2013

© 2013 by Lippincott Williams & Wilkins