title: Reasons for current practices in managing Barrett's esophagus.
abstract: We evaluated the reasons for current practices in managing Barrett's esophagus. Using a questionnaire, we assessed the practices and beliefs of 162 Californian gastroenterologists in managing Barrett's esophagus, using descriptive statistics as well as multivariate logistic regression. Out of the 103 respondents, 87% screened for Barrett's esophagus in patients with > 12 months of reflux symptoms, but only 72% believed that screening would improve survival, and 48% believed it to be cost-effective. In total, 98% surveyed patients with long-segment Barrett's esophagus at least biennially (76% thought this would improve survival and 49% believed it to be cost-effective) and 82% surveyed short-segment Barrett's esophagus at least biennially (57% thought this would improve survival and 30% believed it to be cost-effective). Finally, 44% surveyed microscopic intestinal metaplasia at least biennially (26% thought this would improve survival and 11% believed it to be cost-effective). In total, 18% performed endoscopic ablation, whereas 3% referred patients with low-grade dysplasia and 85% referred patients with high-grade dysplasia for esophagectomy. Finally, 81% treated asymptomatic Barrett's esophagus patients with proton pump inhibitors, but only 56% believed that this would reduce the risk of cancer. Logistic regression showed that the only independent factor predictive of surveillance practices was belief in efficacy. Practice patterns tend to be more aggressive than those recommended by recent guidelines and those reported by previous surveys. Medico-legal considerations affect practice substantially.
authors.affiliation: Division of Gastroenterology, Stanford University Medical Center, California, USA. otto.lin@vmmc.org
authors.forename: Otto S
authors.initials: OS
authors.lastname: Lin
authors.forename: S
authors.initials: S
authors.lastname: Mannava
authors.forename: K-L
authors.initials: KL
authors.lastname: Hwang
authors.forename: G
authors.initials: G
authors.lastname: Triadafilopoulos
mesh_terms: D001291:Attitude of Health Personnel; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000628:therapy*; D002140:California; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D004938:Esophageal Neoplasms / Q000517:prevention & control*; D005260:Female; D005762:Gastroenterology / Q000379:methods; D005764:Gastroesophageal Reflux / Q000188:drug therapy; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000008:administration & dosage; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors; D017494:Proton Pumps