Gastro-oesophageal reflux, medical resource utilization and upper gastrointestinal endoscopy in patients at risk of oesophageal adenocarcinoma.
BACKGROUND
Early identification of patients at risk of oesophageal adenocarcinoma (OAC) might improve survival.


OBJECTIVE
To assess the medical resource utilization in the 3 years before OAC diagnosis as potential markers for early identification and intervention.


METHODS
We identified 65 incident OAC within the Integrated Primary Care Information database. For comparison, we randomly selected 260 age- and gender-matched population controls. We abstracted the use of gastric acid inhibitors, general practitioner (GP) and specialist care, and gastroscopies in the 3 years before the detection of OAC.


RESULTS
Approximately 20% of the cases used gastric acid inhibitors in the third and second year before OAC, which increased to almost 50% in the last year, compared to approximately 10% among controls. Only in the 6 months before OAC, the proportion of patients visiting a GP (97%) or specialist (41%) increased compared to controls. Of 13 gastroscopies performed in the 3 years, six (46%) were not suspect for a malignancy.


CONCLUSIONS
Only a minority of all OAC patients used acid inhibitors before diagnosis. The use of medical care between cases and controls differed only in the final year before OAC diagnosis. Detection of early neoplastic changes proves to be difficult.
Van Soest
E M
EM
Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands. e.vansoest@erasmusmc.nl
Dieleman
J P
JP
Sturkenboom
M C J M
MC
Siersema
P D
PD
Kuipers
E J
EJ
D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis / Q000401:mortality; D016022:Case-Control Studies; D016099:Endoscopy, Gastrointestinal / Q000401:mortality / Q000706:statistics & numerical data*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D040841:Resource Allocation / Q000639:trends*; D012307:Risk Factors; D015996:Survival Rate