Prevalence of Barrett’s Esophagus and Performance of Societal Screening Guidelines in an Unreferred Primary Care Population of U.S. Veterans

Authors

Theresa H Nguyen
Aaron P Thrift
Massimo Rugge
Hashem B El-Serag

Publication Date

2-1-2021

Journal

Gastrointestinal Endoscopy

DOI

10.1016/j.gie.2020.06.032

PMID

32565183

PMCID

PMC7749069

PubMedCentral® Posted Date

2-1-2022

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Barrett Esophagus, Cross-Sectional Studies, Gastroesophageal Reflux, Humans, Prevalence, Primary Health Care, Prospective Studies, Retrospective Studies, Risk Factors, Veterans

Abstract

BACKGROUND AND AIMS: Less than 10% of patients diagnosed with esophageal adenocarcinoma have a pre-existing Barrett's esophagus (BE) diagnosis, possibly because of suboptimal performance of guidelines. We examined the prevalence of BE in a previously unscreened primary care population and the potential yield of practice BE screening guidelines.

METHODS: This was a retrospective analysis of a prospective cross-sectional study of consecutively recruited unreferred patients from primary care clinics who underwent study upper endoscopy. We examined the performance of BE screening guidelines of the European Society of Gastrointestinal Endoscopy (ESGE), British Society of Gastroenterology (BSG), American Society for Gastrointestinal Endoscopy (ASGE), American College of Gastroenterology (ACG), American Gastroenterological Association (AGA), and our own modification of guidelines.

RESULTS: We identified 44 BE cases and 469 control subjects (prevalence, 8.6%). Among 371 patients without GERD symptoms, 25 (6.7%) had BE. The AGA guidelines requiring ≥2 BE risk factors had sensitivity of 100% and specificity of only .2%, whereas ACG, ASGE, ESGE, and BSG guidelines (all requiring GERD first) had low sensitivities (38.6%-43.2%), specificities ranging from 67.4% to 76.5%, and area under the receiver operating curve (AUROC) of .50 to .60. Our 2-pronged approach depending on presence or absence of GERD symptoms but with other risk factors achieved sensitivity of 81.8%, specificity of 51.2%, and AUROC of .66.

CONCLUSIONS: Over half of BE cases were without frequent GERD symptoms, but virtually all had at least 1 known BE risk factor. Practice guidelines requiring GERD symptoms have low sensitivity, whereas those not requiring GERD have low specificity. We have proposed a screening guideline with better use of known risk factors.

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