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Clinical Utility and Acceptance of Esophageal Capsule Endoscopy for Evaluation of Patients with Chronic Heartburn Not Seeking Traditional Care

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Golding, Martin I., M.D., F.A.C.G.; Raskulinecz, Stephanie, R.N.; Doman, David B., M.D., F.A.C.G.; Goldberg, Howard J., M.D., F.A.C.G.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S31
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Montgomery Gastroenterology, Silver Spring, M.D.

Purpose: Chronic heartburn affects as many as 10 million US citizens over 50 years of age. Many individuals may not seek medical care as a result of milder symptoms or reluctance to undergo an invasive procedure. This study evaluates the utility and acceptance of esophageal capsule endoscopy (ECE) in patients with chronic heartburn who are not seeking traditional medical care.

Methods: Subjects with at a minimum of 2 episodes of heartburn a week during the past 6 months were recruited from the community. Subjects who had undergone an upper endoscopy within 5 years or had dysphagia were excluded. Subjects completed a pre-study questionnaire to determine heartburn day and nocturnal frequency, duration, use of medications and impact on QOL prior to undergoing ECE. Data is presented on the first 13 of 40 subjects.

Results: Six subjects reported discussing their heartburn with their primary physician, and 9 were using daily or almost daily heartburn medication. Barrett's esophagus (BE) appearing mucosa was seen in 6 subjects, and 5 subjects had esophagitis (LA Class A/B:4; LA Class C/D:1). Two subjects had non-obstructing esophageal strictures and one subject had findings suggestive of an esophageal carcinoma. The majority of subjects responded that they would consider undergoing an endoscopy evaluation if the ECE showed significant abnormal findings. Nine of the 11 subjects over 50 years of age had undergone a colonoscopy for cancer screening in the past. Other measures of heartburn symptoms are summarized in Table 1.

Table 1

Table 1

Conclusions: This preliminary study suggests that esophagitis and possible BE are common in heartburn sufferers who have not previously sought medical attention. All of the subjects were aware of the increased cancer risk associated with chronic heartburn, although only a minority of the subjects discussed this complaint with their primary physician. Subjects with possible BE tended to have symptoms of a longer duration and more frequent nocturnal symptoms. ECE appears to be a useful and well-accepted method for screening for GERD complications in a population less inclined to seek traditional medical evaluation.

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