Does Barrett's oesophagus develop over time in patients with chronic gastro-oesophageal reflux disease?
BACKGROUND
Barrett's oesophagus is present in 8-10% of patients with gastro-oesophageal reflux disease (GERD).


OBJECTIVE
We performed a cohort study to determine the incidence of Barrett's oesophagus in patients with chronic heartburn symptoms.


METHODS
We identified patients, with GERD and/or Barrett's oesophagus between 1998 and 2004 by primary or secondary International Classification of Diseases (ICD-9) codes of 530.81 and/or 530.2, who had two or more oesophagogastroduodenoscopies performed at least 6 months apart.


RESULTS
We screened 11 040 patients (41 390 random data entries by ICD-9 code) and enrolled 515 (4.6%) GERD patients and 169 (1.5%) Barrett's oesophagus patients. The mean (+/-s.d.) number of oesophagogastroduodenoscopies in the GERD cohort was 3.2 +/- 1.8 (range: 2-15) over 3.4 +/- 2.2 (range: 0.5-11) years. None of the 412 (80%) GERD patients with non-erosive disease developed Barrett's oesophagus over a mean follow-up time of 3.4 +/- 2.2 years (95% CI: 0-0.9%). Five (1%) of the 103 GERD patients with erosive oesophagitis developed subsequent Barrett's oesophagus. Fifty-seven per cent of the GERD patients were on PPI therapy at the time of index endoscopy. None of the 169 Barrett's oesophagus patients had normal index oesophagogastroduodenoscopies within a mean retrospective time period of 4.5 +/- 2.8 years (95% CI: 0-2%). Using the ICD-9 code of 530.2 as a predictor of the presence of Barrett's oesophagus, the sensitivity was 79% with a specificity of 88%.


CONCLUSIONS
The majority of patients with GERD do not appear to develop Barrett's oesophagus when it is not present on the index endoscopy.
Stoltey
J
J
Department of Medicine and Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
Reeba
H
H
Ullah
N
N
Sabhaie
P
P
Gerson
L
L
D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000209:etiology*; D015331:Cohort Studies; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors