title: Gastroesophageal reflux disease symptom severity, proton pump inhibitor use, and esophageal carcinogenesis.
abstract: OBJECTIVE
  Screening for esophageal adenocarcinoma has focused on identifying Barrett esophagus (BE) in patients with severe, long-standing symptoms of gastroesophageal reflux disease (GERD). Unfortunately, 95% of patients who develop esophageal adenocarcinoma are unaware of the presence of BE before their cancer diagnosis, which means they never had been selected for screening. One possible explanation is that no correlation exists between the severity of GERD symptoms and cancer risk. We hypothesize that severe GERD symptoms are not associated with an increase in the prevalence of BE, dysplasia, or cancer in patients undergoing primary endoscopic screening.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A total of 769 patients with GERD.
  
  
  METHODS
  Primary screening endoscopy performed from November 1, 2004, through June 7, 2007.
  
  
  METHODS
  Symptom severity, proton pump inhibitor therapy, and esophageal adenocarcinogenesis (ie, BE, dysplasia, or cancer).
  
  
  RESULTS
  Endoscopy revealed adenocarcinogenesis in 122 patients. An increasing number of severe GERD symptoms correlated positively with endoscopic findings of esophagitis (odds ratio, 1.05; 95% confidence interval, 1.01-1.09). Conversely, an increasing number of severe GERD symptoms were associated with decreased odds of adenocarcinogenesis (odds ratio, 0.94; 95% confidence interval, 0.89-0.98). Patients taking proton pump inhibitors were 61.3% and 81.5% more likely to have adenocarcinogenesis if they reported no severe typical or atypical GERD symptoms, respectively, compared with patients taking proton pump inhibitors, who reported that all symptoms were severe.
  
  
  CONCLUSIONS
  Medically treated patients with mild or absent GERD symptoms have significantly higher odds of adenocarcinogenesis compared with medically treated patients with severe GERD symptoms. This finding may explain the failure of the current screening paradigm in which the threshold for primary endoscopic examination is based on symptom severity.
authors.affiliation: Division of Thoracic and Foregut Surgery, Universty of Pittsburgh, Pittsburgh, PA 15232, USA.
authors.forename: Katie S
authors.initials: KS
authors.lastname: Nason
authors.forename: Promporn Paula
authors.initials: PP
authors.lastname: Wichienkuer
authors.forename: Omar
authors.initials: O
authors.lastname: Awais
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schuchert
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: Robert W
authors.initials: RW
authors.lastname: O'Rourke
authors.forename: John G
authors.initials: JG
authors.lastname: Hunter
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Morris
authors.forename: Blair A
authors.initials: BA
authors.lastname: Jobe
mesh_terms: D001471:Barrett Esophagus / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D054328:Proton Pump Inhibitors