S474 Barrett's Esophagus in the United States From 2005-2016: Analysis of Office Visits From the National Ambulatory Medical Care Survey

Abstract

Introduction: Barrett’s Esophagus (BE) is a premalignant condition by which metastatic columnar mucosa replaces the normal stratified squamous mucosa in the distal esophagus. Most cases occur in older white males with a long-standing history of acid reflux. Our aim was to conduct a cross-sectional study examining trends in demographics and medications use of BE patients in the US from 2005-2016. Methods: The CDC’s National Ambulatory Medical Care Survey (NAMCS) uses weighted sampling methods to generate cross-sectional data representative of ambulatory care visits in the US. Using ICD-9 code 530.85 (BE), we identified patients with BE for the period 2005-2016. For these patients, we identified patients with GERD (ICD-9 530.81 or 530.11) and used visit codes to identify presenting symptoms and drug codes to evaluate PPI and H2 blocker use. Weighting of encounters using SPSS were performed to provide population estimates. Results: There were 6,803,008 unique outpatient visits for BE. Mean age was 61.2 ± 14.7y, 57.9% male, and 95.6% non-Hispanic white. Mean age in males was 58.7±14.5y vs females 64.8 ± 14.3y (p< 0.01). Median BMI was 25.8, 16.6% of patients were obese, and 14.8% had current tobacco use. Overall, 69.6% of visits were to a gastroenterologist (GI), 26.9% to a primary care provider (PCP), and 3.5% to surgery. Mean time spent per visit was 21.8± 11.2m. Among presenting complaints for the visit, 7.4% had abdominal pain, 5.6% had dysphagia, 2.8% with heartburn, and most had no GI complaints. 34.6% of patients had concomitant GERD. Most patients were on PPI therapy (69.4%): 23.4% on esomeprazole, 23.3% omeprazole, 14.1% pantoprazole, and 8.8% lansoprazole. 29.5% were no PPI or H2 blocker, 5.6% were on H2 blocker in addition to PPI, and 5.6 % were on aspirin. PPI use has significantly decreased from 86.3% in 2005-2008 to 62.7% in 2009-2012 to 62.1% in 2013-2016 (p< 0.01). Conclusion: Our nationwide results reaffirm that BE predominantly affects older, obese, white, males. Over one-third of BE patients had GERD, which is 3 times higher than the general population supporting the association. Most BE patients were asymptomatic during their office visit and were primarily seen by a GI specialist. Current guidelines recommend indefinite PPI use for patients with BE; our study showed that though most were on PPI, one-third of patients are not at their office visits when predominantly asymptomatic and PPI use has decreased over time. Continued vigilance in treating patients with BE is needed.