3524 UNCOMPLICATED CHRONIC HEARTBURN: ARE BIOPSIES NECESSARY DURING SCREENING ENDOSCOPY?

Abstract

Introduction: Heartburn is common and frequently self-treated with antacids. Controversy continues regarding the role of endoscopy (EGD) and biopsy (Bx) in such persons in terms of impact on therapy or prognosis. An epidemiologic study performed at 2 urban centers has characterized non-consulting chronic heartburn sufferers (Arch Intern Med 1998;158:2373). Initial endoscopic data demonstrated an apparent 6% incidence of Barrett s esophagus (BE) and 47% erosive esophagitis (≥grade 2). Two subjects were excluded due to dysplastic Barrett s mucosa detected at baseline. Formal data from endoscopic Bx obtained in this OTC setting have not been reported. Aim: To clarify clinical significance of Bx findings from screening EGD in individuals with ≥ 4 episodes of heartburn per week of 10 year duration. Methods: Endoscopic Bx s were taken at the squamocolumnar junction (SC) and at 3 cm above the SC at baseline and after 6 weeks of treatment with ranitidine 150 mg bid or antacids. Results: Histologic BE was documented in 2% of all evaluable Bx s (N=122) at baseline, and short segment Barrett s (SSBE) was found in an additional 2% (N=122) at the SC. Measurable inflammation was documented in 98% of all Bx s, with epithelial hyperplasia in 71%. At week 6, BE was found in 2.25% of all Bx s, with epithelial inflammation in 33.3% and epithelial hyperplasia in 77%. Summary: Suspected high prevalence of SSBE was not corroborated in our study. Conventional BE also was relatively uncommon in this non-consulting population. Histologic evidence of inflammation including epithelial hyperplasia was highly prevalent. Acute inflammation was improved but chronic changes of epithelial hyperplasia were not grossly altered by 6 weeks of therapy with antacids or ranitidine. Bx findings did not change clinical impression by endoscopy except for indicating less BE than suspected by gross inspection. Conclusions: Although duration of symptoms correlates with endoscopic esophagitis grade, neither EGD nor Bx seem helpful for acute management of most patients presenting with chronic heartburn. Based on these findings, the 6-10% endoscopic prevalence of BE previously reported in other trials may represent a significant overestimate for non-consulting heartburn sufferers. Histology may be critical to confirm or refute the presence of BE as well as dysplasia.