Duration of Heartburn Is the Only Symptom Characteristic That Distinguishes Between Patients with Long Segment (LSBE) and Those with Short Segment Barrett's Esophagus (SSBE)

Abstract

Purpose: Symptom characteristics of GERD, such as duration, severity or frequency have been suggested to be predictive of BE. However, thus far there are no studies that have assessed the value of these symptom characteristics in identifying patients with SSBE versus those with LSBE. Aim: To determine if any of the symptom characteristics of gastroesophageal reflux disease (GERD) can distinguish between patients with LSBE and those with SSBE. Methods: Patients seen in our Barrett's clinic were prospectively approached and asked to participate in this study. All patients underwent an endoscopy, which carefully documented the length of their Barrett's mucosa by an experienced endoscopist. LSBE was defined as ≥3 cm and SSBE as <3 cm. Characteristics of GERD symptoms were evaluated by the previously validated GERD symptoms Checklist. Analysis focused on 4 domains, duration of symptom (years), frequency of symptom (per week), severity of symptom (1-4 scale) and symptom intensity (calculated as frequency × severity). Results: 88 BE patients were recruited into the study. 47 had SSBE (mean age 67.6 ± 1.4, range- 51-86, M/F-46/1) and 41 LSBE (mean age 68.0 ± 2.0, range- 29-86, M/F-38/3). 44 (93.6%) of the SSBE patients and 38 (92.7%) of the LSBE patients reported heartburn. There was no significant difference in the frequency, severity and intensity of heartburn between the SSBE and the LSBE group (17.0 ± 1.8 vs. 16.7 ± 2.3 p=0.9, 2.7 ± 0.1 vs. 2.6 ± 0.1 p = 0.4 and 46.4 ± 5.3 vs. 46.3 ± 6.7 p=1.0, respectively). However, duration of heartburn symptom was significantly longer in the LSBE group as compared to the SSBE group (31.0 ± 3.0 vs. 24.5 ± 2.2, p<0.05). 38 (81%) of SSBE patients and 34 (83%) of LSBE patients reported regurgitation. There was no significant difference in the duration, frequency, severity and intensity of regurgitation symptom between patients with SSBE and those with LSBE (p=0.4, p=0.9, p=0.3 and p=0.6, respectively). No difference in the prevalence and symptom characteristics of nocturnal GERD symptoms, chest pain and dysphagia was found between the two BE groups. Conclusion: Duration of heartburn symptom is the sole symptom characteristic that distinguishes between patients with LSBE (higher risk for esophageal cancer) and those with SSBE (lower risk for esophageal cancer).