title: Barrett's esophagus specialist clinic: what difference can it make?
abstract: A 'Barrett's specialist clinic' was set up in our institution consisting of a specialist nurse, research fellow, and a consultant gastroenterologist. The aim of our study was to examine the impact of this clinic in the management of patients with Barrett's esophagus (BE). Patients with the diagnosis of BE seen in the outpatient departments or in the endoscopy unit were referred to this clinic. Guidelines were introduced modelling the American College of Gastroenterology recommendation. Patients were assessed based on their comorbidity and willingness to undergo surveillance. Reflux symptom control and acid suppression was addressed. All patients were invited to undergo high-resolution enhanced magnification endoscopy (EME) and targeted biopsy to confirm the diagnosis and to form a management plan. During the appointment in the clinic, patients were given an option to fill a questionnaire that inquired about the information given to them regarding BE. One hundred and forty-three patients (92 men, mean age: 62 years) with a diagnosis of BE were seen in the specialist clinic. In 16 patients surveillance was stopped. In 25 patients treatment was changed due to poor control of reflux symptoms. Sixty-five patients (51%) answered the questionnaire. Seventy-five patients (58%) underwent high resolution EME. Twelve patients, had a histological upgrade after EME, in spite of a short mean screening interval (5.5 months). The 'Barrett's specialist clinic' introduced a more structured approach in our institution and changed the way these patients were managed. Our results indicate the need for local guidelines and Barrett's specialist clinics in the UK, and perhaps in the rest of the Western world, wherein the burden of this condition is increasing.
authors.affiliation: Wolfson Digestive Diseases Center and Department of Histopathology, University Hospital NHS Trust, Nottingham, United Kingdom.
authors.forename: G K
authors.initials: GK
authors.lastname: Anagnostopoulos
authors.forename: B
authors.initials: B
authors.lastname: Pick
authors.forename: R
authors.initials: R
authors.lastname: Cunliffe
authors.forename: P
authors.initials: P
authors.lastname: Fortun
authors.forename: P
authors.initials: P
authors.lastname: Kaye
authors.forename: K
authors.initials: K
authors.lastname: Ragunath
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods / Q000592:standards; D005260:Female; D005762:Gastroenterology / Q000592:standards*; D006801:Humans; D008297:Male; D008511:Medicine / Q000592:standards*; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D017410:Practice Guidelines as Topic; D013038:Specialization; D011795:Surveys and Questionnaires; D006113:United Kingdom