title: Prevalence and predictors of columnar lined esophagus in gastroesophageal reflux disease (GERD) patients undergoing upper endoscopy.
abstract: OBJECTIVE
  Chronic gastroesophageal reflux disease (GERD) is a risk factor for Barrett's esophagus (BE), the most important surrogate marker for the development of esophageal adenocarcinoma (EAC). The need to document the presence of intestinal metaplasia in esophageal biopsies from a columnar lined esophagus (CLE) to diagnose BE is debated. The objective of this study was to prospectively evaluate the prevalence and risk factors of CLE in a large cohort of GERD patients undergoing upper endoscopy.
  
  
  METHODS
  Consecutive patients presenting to the endoscopy unit at a tertiary referral center for their index upper endoscopy for evaluation of GERD symptoms were enrolled in this prospective cohort study. Patients were asked to complete a validated GERD questionnaire that documents the onset of GERD symptoms (heartburn and acid regurgitation) and grades the frequency and severity of symptoms experienced over the past year. Demographic information, body mass index, and use of aspirin/nonsteroidal antiinflammatory drugs were recorded. Endoscopic details including length of CLE, presence and size of hiatal hernia were noted. Patients with CLE (cases) were compared with those without CLE (controls) using Fischer's exact test and t-test. All factors that were statistically significant (P<0.05) were then entered into stepwise logistic regression to evaluate for independent predictors of CLE.
  
  
  RESULTS
  A total of 1058 patients with GERD symptoms were prospectively enrolled. On index endoscopy, the prevalence of CLE was 23.3%, whereas of CLE with documented intestinal metaplasia was 14.1%. On univariate analysis, male gender, Caucasian race, heartburn duration of >5 years, presence and size of hiatal hernia were significantly associated with the presence of CLE compared with controls (P<0.05). On multivariate analysis, heartburn duration >5 years (odds ratio (OR): 1.50, 95% confidence interval (CI): 1.07-2.09, P=0.01), Caucasian race (OR: 2.40, 95% CI: 1.42-4.03, P=0.001), and hiatal hernia (OR: 2.07, 95% CI: 1.50-2.87, P<0.01) were found to be independent predictors for CLE. CLE length was significantly associated with the presence of intestinal metaplasia (P<0.001).
  
  
  CONCLUSIONS
  If BE is defined by the presence of CLE alone on upper endoscopy, up to 25% of GERD patients are diagnosed with this lesion. Enrolling all these patients in surveillance programs would have significant ramifications on health-care resources.
authors.affiliation: Department of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri 64128-2295, USA.
authors.forename: Gokulakrishnan
authors.initials: G
authors.lastname: Balasubramanian
authors.forename: Mandeep
authors.initials: M
authors.lastname: Singh
authors.forename: Neil
authors.initials: N
authors.lastname: Gupta
authors.forename: Srinivas
authors.initials: S
authors.lastname: Gaddam
authors.forename: Maria
authors.initials: M
authors.lastname: Giacchino
authors.forename: Sachin B
authors.initials: SB
authors.lastname: Wani
authors.forename: Brian
authors.initials: B
authors.lastname: Moloney
authors.forename: April D
authors.initials: AD
authors.lastname: Higbee
authors.forename: Amit
authors.initials: A
authors.lastname: Rastogi
authors.forename: Ajay
authors.initials: A
authors.lastname: Bansal
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
mesh_terms: D001471:Barrett Esophagus / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology* / Q000473:pathology; D001706:Biopsy; D015992:Body Mass Index; D016022:Case-Control Studies; D004945:Esophagoscopy; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000453:epidemiology* / Q000208:ethnology / Q000473:pathology; D006551:Hernia, Hiatal / Q000150:complications / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013997:Time Factors