Clinical and endoscopic predictors of barrett's esophagus (BE) at the index endoscopy
Background: There are currently no studies evaluating the factors predictive of BE at the time of endoscopy. Aim: To determine the clinical and endoscopic predictors of BE at the time of index endoscopy. Methods: From September 1993 to October 1997 endoscopic reports were examined to identify patients suspected to have BE. One hundred forty six patients not previously known to have BE were identified and their pathology reports were reviewed. Univariate analysis and multivariate logistic regression were performed. The presence of BE on pathology was used as the outcome variable while age, race and heartburn as an indication for the endoscopy, and the length of the columnar appearing segment were used as predictor variables. Results: Eight percent of all procedures and 12% of outpatient procedures were performed for suspected or confirmed BE. The prevalence of BE was 7.5%. and the incidence was 4.35%. BE was suspected in 13% of all outpatients. Of 146 patients suspected to have BE, 71% were classified as short segment BE (SSBE, ≤ 2 cm) by the endoscopist. Of those who had confirmed BE, 90% were white and 10% were black. SSBE LSBE SEX MALE (%) 98 98 RACE WHITE (%) 72 86 HEARTBURN (%) 46 48 AGE ± SD 59 ± 13 61 ± 15 LENGTH (CMS) 1.73 ± 0.46 5.64 ± 3.26 PROVEN BE (%) 25 55 Univariate analysis showed that endoscopists predicted BE in those with LSBE more accurately than those with SSBE (55% vs 25% p=0.001), (OR = 3.63, 95% CI 1.71-7.7). Barrett's esophagus was accurately predicted in 38.5% of white patients but in only 14.7 % of black patients (p=0.01), (OR = 3.63, 95% CI 1.31-10.13). Heartburn as an indication for the endoscopy and age greater than 50 years were not predictive of BE (P= 0.685 and 0.74 respectively). Multivariate logistic regression identified only the length of the columnar appearing segment as significant p=0.002 (OR = 3.33 95% CI 1.54-7.17), with race trending towards significance (p=0.08) (OR = 2.31 95% CI 0.88-6.03) (white patients were more likely to be diagnosed with BE). Conclusions: 1) The endoscopic diagnosis of BE patients remains a challenge especially for those with SSBE. 2)The length of the columnar appearing segment is the strongest predictor of BE at endoscopy.
Eloubeidi, M; Provenzale, D
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