Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
Purpose: BE patients may not complain of heartburn. We recorded the the reasons for referral for endoscopy and the type and duration of risk factors that may affect development and progression of BE.
Methods: 112 patients with BE were studied during 2002–4. Indications for endoscopy, duration of symptoms, and risk factors were analyzed. Lengths of BE and hiatal hernia (HH) were measured to the nearest cm, using the markings on the endoscope. Long-segment BE patients (LSBE) were classified as ≥3 cm of BE and short-segment patients (SSBE) as <3 cm. Fisher's Exact tests and t-tests were calculated using Stata 8.2/SE.
Results: Heartburn and regurgitation were the principal indication for endoscopy in 44.4% (24/54) LSBE and 51.7% (30/58) SSBE although a total of 83.3% (45/54) and 72.4% (42/58) respectively, had complained of heartburn. Chronic cough was the indication for endoscopy in 1.9% (1/54) LSBE and 5.2% (3/58) SSBE, but present in a total of 25.9% (14/54) and 22.4% (13/58), respectively. Acute upper gastrointestinal bleeding was a more common indication for endoscopy in LSBE (16.7%, 9/54) vs. SSBE (1.7%, 1/58); p = 0.007. Dysplasia or cancer was found in 12.7% (7/56) current or former smokers and in no (0/53) non-smokers; p = 0.013. In patients who used alcohol mean HH length was 4.15 cm (1.7) compared to those who did not drink 3.24 cm (1.4), p = 0.016, and mean length of BE was 4.50 cm (2.9) compared with 3.25 cm (2.2) p = 0.040. Patients who reported a weight gain of ≥ 5 kg in the previous 5 yr had a HH length of 3.65 cm (1.6) vs. 2.82 cm (1.3); p = 0.006. Patients who had at least one of these risk factors were diagnosed significantly earlier than those who had none; 52.7 yr (13.8) compared to 61.3 yr (15.1), p = 0.029
Conclusions: Careful inspection of the lower esophagus is essential in patients with indications for endoscopy other than heartburn and regurgitation, as this may lead to initial diagnosis of BE. We have demonstrated that BE patients frequently do not complain of heartburn and regurgitation as prominent symptoms at presentation. Physicians should ensure that an adequate history is obtained regarding these symptoms. Physicians should emphasize lifestyle modifications in patients with chronic reflux as a weight gain of ≥ 5 kg in the previous 5 years, smoking and alcohol use may contribute to an earlier onset of BE and/or increase the incidence and severity of BE and its associated symptoms.