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Patients with GERD often afflicted with columnar lined esophagus
Columnar lined esophagus is common among patients with GERD, but relying on the condition alone to diagnose Barrett’s esophagus may significantly inflate resource utilization and care costs, according to a recent study.
Researchers evaluated 1,058 patients with GERD symptoms admitted to the Veterans Affairs Medical Center in Kansas City, Mo., between 2000 and 2011. Patients underwent upper endoscopy and responded to questionnaires covering topics including the onset, frequency and severity of their symptoms. Results were compared between patients with and without columnar lined esophagus (CLE). Investigators also assessed the effectiveness of diagnosing Barrett’s esophagus (BE) solely on the presence of CLE, as is practiced in the UK and Asia.
CLE was present in 23.3% of patients, including 14.1% who had CLE with intestinal metaplasia. Prevalence for the condition decreased over time, but not significantly, with rates of 24.5% between 2000 and 2002, 25.3% from 2003-2005, 21.7% from 2006-2008 and 16.7% from 2009-2011 (P=.19). The average CLE length was 2.12 cm, with the vast majority of participants having a length longer than 1 cm (97%) Investigators observed a significant association between intestinal metaplasia and longer CLE (P<.01).
Patients with CLE were more likely to be male (95.9% of those with CLE compared with 90.1% without, P=.01), Caucasian (89.8% compared with 80.0%, P<.01), older (mean age 58.7 ± 11.75 years compared with 56.8 ± 12.9, P=.04) and have a hiatal hernia (64.7% vs. 43.7%, P<.01) and heartburn duration of more than 5 years (61.9% vs. 48.9%, P=.01). Multivariate analysis indicated associations between CLE of 1 cm and longer and hiatal hernia (OR=2.60, 1.84-3.66) and Caucasian race (OR=2.57, 1.46-4.54) (95% CI for both). No significant predictors were observed for CLE lengths of less than 1 cm.
“We report that CLE is highly prevalent among veterans with GERD,” the researchers wrote. “Nearly 25% of patients with GERD undergoing endoscopy had [BE] as defined by the mere presence of CLE. This has significant implications for endoscopic surveillance, resource utilization and costs to the health care system.”