The potential impact of contemporary developments in the management of patients with gastroesophageal reflux disease undergoing an initial gastroscopy.
BACKGROUND
Recent developments may alter the approach to patients presenting with gastroesophageal reflux disease (GERD)-like symptoms. A newly proposed Montreal consensus definition of Barrett's esophagus includes all types of esophageal columnar metaplasia, with or without intestinal-type metaplasia. There is also increasing recognition of eosinophilic esophagitis (EE) in patients with GERD-like symptoms.


OBJECTIVE
To quantify the impact of these developments on a multiphysician general gastroenterology practice in a tertiary care medical centre.


METHODS
Medical charts of all patients having an initial gastroscopy for GERD-like symptoms over a one-year period were reviewed retrospectively, and audits of their endoscopic images and esophageal biopsies were performed.


RESULTS
Of the 353 study participants, typical symptoms of heartburn and acid reflux were present in 87.7% and 23.2%, respectively. Less commonly, patients presented with atypical symptoms (eg, dysphagia in 9.4%). At endoscopy, 26% were found to have erosive esophagitis and 12% had endoscopically suspected esophageal metaplasia. Histological evaluation was available for 65 patients. Ten of the 65 biopsied patients (15%) met traditional criteria for Barrett's esophagus (ie, exhibiting intestinal-type metaplasia), whereas 49 (75%) fulfilled the newly proposed consensus definition of Barrett's esophagus. Five patients (7.7%) met the study criteria for EE (more than 20 eosinophils per high-power field), four of whom had not been previously recognized.


CONCLUSIONS
Among patients presenting with GERD-like symptoms, the prevalence of Barrett's esophagus may increase markedly if the Montreal definition is adopted. In addition, growing awareness of EE may lead to an increase in the prevalence of this diagnosis. Prospective studies of the management implications of these findings are warranted.
Salem
Suhail B
SB
Department of Pathology, McGill University Health Centre, McGill University, and Montreal General Hospital Site, Montreal, Quebec, Canada.
Kushner
Yael
Y
Marcus
Victoria
V
Mayrand
Serge
S
Fallone
Carlos A
CA
Barkun
Alan N
AN
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology*; D015984:Causality; D015897:Comorbidity; D003937:Diagnosis, Differential; D004802:Eosinophilia / Q000175:diagnosis* / Q000453:epidemiology; D004941:Esophagitis / Q000175:diagnosis* / Q000453:epidemiology; D004947:Esophagus / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000453:epidemiology; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D009626:Terminology as Topic; D055815:Young Adult