title: Gastro-esophageal reflux disease symptoms and demographic factors as a pre-screening tool for Barrett's esophagus.
abstract: BACKGROUND
  Barrett's esophagus (BE) occurs as consequence of reflux and is a risk factor for esophageal adenocarcinoma. The current "gold-standard" for diagnosing BE is endoscopy which remains prohibitively expensive and impractical as a population screening tool. We aimed to develop a pre-screening tool to aid decision making for diagnostic referrals.
  
  
  RESULTS
  A prospective (training) cohort of 1603 patients attending for endoscopy was used for identification of risk factors to develop a risk prediction model. Factors associated with BE in the univariate analysis were selected to develop prediction models that were validated in an independent, external cohort of 477 non-BE patients referred for endoscopy with symptoms of reflux or dyspepsia. Two prediction models were developed separately for columnar lined epithelium (CLE) of any length and using a stricter definition of intestinal metaplasia (IM) with segments ≥ 2 cm with areas under the ROC curves (AUC) of 0.72 (95%CI: 0.67-0.77) and 0.81 (95%CI: 0.76-0.86), respectively. The two prediction models included demographics (age, sex), symptoms (heartburn, acid reflux, chest pain, abdominal pain) and medication for "stomach" symptoms. These two models were validated in the independent cohort with AUCs of 0.61 (95%CI: 0.54-0.68) and 0.64 (95%CI: 0.52-0.77) for CLE and IM ≥ 2 cm, respectively.
  
  
  CONCLUSIONS
  We have identified and validated two prediction models for CLE and IM ≥ 2 cm. Both models have fair prediction accuracies and can select out around 20% of individuals unlikely to benefit from investigation for Barrett's esophagus. Such prediction models have the potential to generate useful cost-savings for BE screening among the symptomatic population.
authors.affiliation: MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Xinxue
authors.initials: X
authors.lastname: Liu
authors.affiliation: MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Angela
authors.initials: A
authors.lastname: Wong
authors.affiliation: MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Sudarshan R
authors.initials: SR
authors.lastname: Kadri
authors.affiliation: MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Andrej
authors.initials: A
authors.lastname: Corovic
authors.affiliation: Department of Histopathology, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: Maria
authors.initials: M
authors.lastname: O'Donovan
authors.affiliation: MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lao-Sirieix
authors.affiliation: University College London Hospital (UCLH), London, United Kingdom.
authors.forename: Laurence B
authors.initials: LB
authors.lastname: Lovat
authors.affiliation: Queen's Hospital, Romford, Essex, United Kingdom.
authors.forename: Rodney W
authors.initials: RW
authors.lastname: Burnham
authors.affiliation: MRC Cancer Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Fitzgerald
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors; D055815:Young Adult
references.citation: Aliment Pharmacol Ther. 2010 Apr;31(8):852-61
references.pmid: 20102354
references.citation: Gastrointest Endosc. 2012 Feb;75(2):236-41
references.pmid: 22248595
references.citation: Cancer Epidemiol Biomarkers Prev. 2010 Jun;19(6):1468-70
references.pmid: 20501776
references.citation: Cancer Cell. 2012 Jan 17;21(1):36-51
references.pmid: 22264787
references.citation: Nat Rev Clin Oncol. 2012 Mar 20;9(5):278-87
references.pmid: 22430857
references.citation: Am J Gastroenterol. 2003 Jul;98(7):1627-33
references.pmid: 12873590
references.citation: Cancer Epidemiol Biomarkers Prev. 2011 Feb;20(2):345-58
references.pmid: 21173169
references.citation: Am J Gastroenterol. 2001 Jul;96(7):2005-12
references.pmid: 11467625
references.citation: Gastroenterology. 2002 Jan;122(1):26-33
references.pmid: 11781277
references.citation: World J Gastroenterol. 2007 Mar 14;13(10):1585-94
references.pmid: 17461453
references.citation: J Clin Gastroenterol. 2014 Mar;48(3):218-23
references.pmid: 23842216
references.citation: Clin Gastroenterol Hepatol. 2014 Aug;12(8):1267-71
references.pmid: 24362047
references.citation: Gastrointest Endosc. 2003 Nov;58(5):661-70
references.pmid: 14595298
references.citation: Aliment Pharmacol Ther. 2007 Jun 15;25(12):1451-9
references.pmid: 17539985
references.citation: Nat Rev Cancer. 2010 Feb;10(2):87-101
references.pmid: 20094044
references.citation: Gut. 2009 Nov;58(11):1451-9
references.pmid: 19651633
references.citation: Scand J Gastroenterol. 2007 Feb;42(2):148-56
references.pmid: 17327933
references.citation: Gastroenterology. 2007 Jul;133(1):34-41; quiz 311
references.pmid: 17631128
references.citation: J Clin Gastroenterol. 2001 Oct;33(4):306-9
references.pmid: 11588545
references.citation: J Natl Cancer Inst. 2011 Jul 6;103(13):1049-57
references.pmid: 21680910
references.citation: Gastroenterology. 2011 Mar;140(3):1084-91
references.pmid: 21376940
references.citation: Clin Gastroenterol Hepatol. 2008 Jan;6(1):30-4
references.pmid: 18063419
references.citation: Gastrointest Endosc. 2012 May;75(5):954-61
references.pmid: 22421496
references.citation: Am J Gastroenterol. 2013 Mar;108(3):353-62
references.pmid: 23318485
references.citation: Am J Gastroenterol. 2008 Mar;103(3):788-97
references.pmid: 18341497
references.citation: Gut. 2008 Oct;57(10):1354-9
references.pmid: 18424568
references.citation: Dig Dis Sci. 2009 May;54(5):964-71
references.pmid: 19255852
references.citation: Gastroenterology. 2011 Mar;140(3):e18-52; quiz e13
references.pmid: 21376939
references.citation: Clin Gastroenterol Hepatol. 2009 Aug;7(8):840-8
references.pmid: 19410015
references.citation: Am J Gastroenterol. 2009 Apr;104(4):834-42
references.pmid: 19319131
references.citation: Am J Gastroenterol. 2009 Jun;104(6):1356-62
references.pmid: 19491849
references.citation: Gut. 2014 Jan;63(1):7-42
references.pmid: 24165758
references.citation: Gastrointest Endosc. 2012 May;75(5):945-953.e2
references.pmid: 22425272
references.citation: Aliment Pharmacol Ther. 2002 Oct;16(10):1795-800
references.pmid: 12269973
references.citation: Am J Epidemiol. 2005 Sep 1;162(5):454-60
references.pmid: 16076833
references.citation: Gastroenterology. 2005 Dec;129(6):1825-31
references.pmid: 16344051
references.citation: Am J Gastroenterol. 2006 Jan;101(1):12-7
references.pmid: 16405528
references.citation: Cancer Prev Res (Phila). 2012 Sep;5(9):1115-23
references.pmid: 22787114
references.citation: BMJ. 2010 Sep 10;341:c4372
references.pmid: 20833740
references.citation: Gastroenterology. 2007 Aug;133(2):403-11
references.pmid: 17681161
references.citation: Gut. 2005 Mar;54 Suppl 1:i1-5
references.pmid: 15711002