Utilization and Acceptance of Wireless Esophageal Capsule Endoscopy for Evaluation of Self-Referred Subjects with Chronic Heartburn

Abstract

Purpose: Upper endoscopy is recommended for patients with GERD at risk for Barrett's esophagus (BE) because of the association with adenocarcinoma of the esophagus. Patients with BE are less likely to report severe heartburn and may be less inclined to seek medical care and undergo invasive screening. The aim of this study is to assess the clinical utility of esophageal capsule endoscopy (ECE) for screening of adults at risk for BE. Methods: Forty subjects over the age of 50 with a minimum of 2 episodes of heartburn a week during the past 6 months were recruited from local newspaper ads to undergo ECE. None of the subjects were currently under the care of a gastroenterologist or had undergone an upper endoscopy in the past five years. The average age of the study group was 61. There were 24 male subjects (62%) and 35 (90%) subjects were white. Subjects completed a pre-study questionnaire rating their heartburn severity, frequency and duration. Results: Erosive esophagitis was identified in 13 studies (32%) (7 males, 6 females). Three subjects had circumferential ulcerations. Subjects with normal studies reported more severe heartburn (33% vs. 15%), and were more likely to use medications for relief of heartburn on most or all days (59% vs. 46%) than subjects with esophagitis. BE appearing mucosal changes were identified in 15 (38%) studies (9 males, 6 females). Subjects with possible BE were more likely to report heartburn over five years in duration (73% vs. 56%) and nocturnal heartburn on most or all nights (40% vs. 24%). Conclusions: This study suggests that esophagitis and BE are common in adults who are self-referred for investigation of chronic heartburn. BE may be more prevalent in a community population with chronic heartburn than reported in clinical studies with referred GERD patients. Subjects with normal studies reported more severe heartburn than subjects with esophagitis or BE. A possible approach for evaluation of patients with chronic GERD without warning symptoms could be to perform an ECE study and then proceed with upper endoscopy and biopsy in only the minority of patients with possible BE.