Background and Aims

Less than 10% of patients diagnosed with esophageal adenocarcinoma have a pre-existing Barrett’s esophagus (BE) diagnosis, possibly because of suboptimal performance of guidelines. We examined the prevalence of BE in a previously unscreened primary care population and the potential yield of practice BE screening guidelines.

Methods

This was a retrospective analysis of a prospective cross-sectional study of consecutively recruited unreferred patients from primary care clinics who underwent study upper endoscopy. We examined the performance of BE screening guidelines of the European Society of Gastrointestinal Endoscopy (ESGE), British Society of Gastroenterology (BSG), American Society for Gastrointestinal Endoscopy (ASGE), American College of Gastroenterology (ACG), American Gastroenterological Association (AGA), and our own modification of guidelines.

Results

We identified 44 BE cases and 469 control subjects (prevalence, 8.6%). Among 371 patients without GERD symptoms, 25 (6.7%) had BE. The AGA guidelines requiring ≥2 BE risk factors had sensitivity of 100% and specificity of only .2%, whereas ACG, ASGE, ESGE, and BSG guidelines (all requiring GERD first) had low sensitivities (38.6%-43.2%), specificities ranging from 67.4% to 76.5%, and area under the receiver operating curve (AUROC) of .50 to .60. Our 2-pronged approach depending on presence or absence of GERD symptoms but with other risk factors achieved sensitivity of 81.8%, specificity of 51.2%, and AUROC of .66.

Conclusions

Over half of BE cases were without frequent GERD symptoms, but virtually all had at least 1 known BE risk factor. Practice guidelines requiring GERD symptoms have low sensitivity, whereas those not requiring GERD have low specificity. We have proposed a screening guideline with better use of known risk factors.

中文翻译：

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Barrett 食管的患病率和社会筛查指南在未转诊的美国退伍军人初级保健人群中的表现。

背景和目标

不到 10% 的被诊断患有食管腺癌的患者有预先存在的巴雷特食管 (BE) 诊断，这可能是因为指南的表现不佳。我们检查了以前未经筛查的初级保健人群中 BE 的患病率以及实践 BE 筛查指南的潜在收益。

方法

这是一项前瞻性横断面研究的回顾性分析，该研究对从初级保健诊所连续招募的未转诊患者进行了研究上消化道内窥镜检查。我们检查了欧洲胃肠内镜学会 (ESGE)、英国胃肠病学会 (BSG)、美国胃肠内镜学会 (ASGE)、美国胃肠病学会 (ACG)、美国胃肠病学会 (AGA) 的 BE 筛查指南的执行情况，以及我们自己修改的指南。

结果

我们确定了 44 例 BE 病例和 469 例对照受试者（患病率，8.6%）。在 371 名没有 GERD 症状的患者中，25 名（6.7%）患有 BE。要求≥2 BE 风险因素的 AGA 指南的敏感性为 100%，特异性仅为 0.2%，而 ACG、ASGE、ESGE 和 BSG 指南（均首先要求 GERD）敏感性低（38.6%-43.2%），特异性范围从 67.4% 到 76.5%，受试者工作曲线下面积 (AUROC) 为 0.50 到 0.60。我们的 2 管齐下的方法取决于 GERD 症状的存在与否，但与其他风险因素一起实现了 81.8% 的敏感性、51.2% 的特异性和 0.66 的 AUROC。

结论

超过一半的 BE 病例没有频繁的 GERD 症状，但几乎所有病例都至少有 1 个已知的 BE 危险因素。需要 GERD 症状的实践指南敏感性低，而那些不需要 GERD 的实践指南特异性低。我们提出了一个更好地利用已知风险因素的筛查指南。