Screening for Barrett's Esophagus in Asymptomatic Women

摘要

Background: Previous studies have suggested that Barrett's esophagus (BE) is detected in 8% of patients with chronic GERD and 5% of asymptomatic subjects underling endoscopy (Rex, Gastro 2003). Barrett's esophagus is more commonly detected in white men over the age of 50. The purpose of this study was to determine the prevalence of Barrett's esophagus in asymptomatic women. Methods: We invited two groups of women to participate: the first were women age > 50 without heartburn symptoms who were undergoing screening colonoscopy, the second group were asymptomatic women with morbid obesity who were undergoing screening upper endoscopy prior to bariatric surgery. Subjects were considered to be asymptomatic if they experienced heartburn symptoms once a month or less that did not require usage of more than antacid therapy. BE was defined as the presence of salmon-colored mucosa in the tubular esophagus with biopsy confirmation of intestinal metaplasia. Biopsy of the distal esophagus was performed in all patients. Validated symptom information was collected using the reflux symptom survey (RSS) scale (Lagergren 1999) and the GERD-HRQL survey (Velanovich 1996). Results: We invited 240 subjects to participate: 2 patients agreed but did not enroll, 9 were excluded because of GERD symptoms > I/month, and 104 (43%) subjects enrolled into the study (indication was screening for CRC in 61 patients and screening pre-bariatric surgery in 43 patients). The mean (+ SD) overall age was 51 + 13 (range 25-79) years (mean age of 41 years in pre-bariatric group versus 58 years in CRC screen group, p < 0.001); 70% were Caucasian, 12.5% asian, 9% Hispanic and 12% of African-american origin. The mean HRQL score was 2.4 + 4 (range 0-20) and the mean RSS score 0.3 + 0.7 (range 0-2). Barrett's esophagus was detected in 6 (5-8%) women (mean age 62 + 13 yrs, range 38-79, 50% from the pre-bariatric patients) and all subjects had short-segments (2 cm or less). Other findings included H. pylori infection in 7%, normal esophagus with histologic evidence of reflux in 11%, erosive esophagitis in 2%, SIM-EGJ in 4%, and 3% patients with both reflux and H. pylori infection. There were no significant differences in the BE and non-BE groups with respect to mean symptom survey scores, mean BMI (44 vs 36, p = 0.4), tobacco or alcohol usage. Conclusions: The prevalence of BE in asymptomatic women is approximately 6% and does not differ significantly compared to the prevalence in patients with GERD. Obesity is a risk factor for both GERD and BE in asymptomatic women.