Barrett's Esophagus (BE) Is Common in Older Patients Undergoing Screening Colonoscopy Regardless of Gastroesophageal Reflux (GER) Symptoms

Abstract

Although GER and BE are the precursor of most, if not all cases of esophageal adenocarcinoma (ACA), most patients with ACA present outside of a BE surveillance program. This could either be due to undiagnosed symptomatic GER/BE or due to BE/ACA occurring in patients without GER symptoms. We are studying the prevalence of BE and GER symptoms in older patients referred for screening or polyp surveillance colonoscopy. Methods: Patients referred for outpatient colonoscopy are eligible if they are at least 65 years old and have previously not undergone upper endoscopy. The patients completed detailed GER questionnaires including an instrument previously validated in patients presenting for upper endoscopy (AJG 2001;96:2005) and a series of four simple, clinically oriented questions inquiring about presence, frequency and duration of heartburn and regurgitation. During the research endoscopy, the endoscopist recorded the squamocolumnar junction (SCJ) as either long segment (>2 cm) BE (LSBE), short segment BE (<2cm) (SSBE) or normal. If the SCJ was felt to be “irregular” the endoscopist was asked to predict, in their judgment, if BE was present. All patients had biopsies of either the BE segment or below a normal appearing SCJ, which were read by a dedicated pathologist blinded to the source of the biopsy. Intestinal metaplasia of the cardia (IMC) was considered present if the SCJ was normal and intestinal metaplasia was found on biopsy. Results: 200 patients have been studied. Percentage of LSBE, SSBE and IMC in total and by gender are in the table. The validated questionnaire did not predict the presence of BE even when lower symptom cut-offs were used. Using the 4 simple questions, 62 (31%) had symptoms consistent with GER and 138 (69%) did not(NS). 17.8% of the symptomatic and 12.3% of the asymptomatic patients had either SSBE or LSBE (NS). All LSBE patients were asymptomatic by both questionnaires. Conclusions: BE (predominantly SSBE) is common in unscreened patients at least 65 years of age who are referred for colonoscopy. Men were twice as likely to have BE. GER symptoms were common (31%), but a poor predictor of BE when evalutated by either a validated questionnaire or a series of simple questions. Supported by grants from American College of Gastroenterology, AstraZeneca and Mayo Foundation.