Gastro-oesophageal reflux symptoms, oesophagitis and Barrett's oesophagus in the general population: the Loiano-Monghidoro study

Zagari, Rocco Maurizio; Fuccio, Lorenzo; Wallander, Mari‐Ann; Johansson, Saga; Fiocca, Roberto; Casanova, S.; Farahmand, Bahman; Winchester, Christopher C; Roda, Enrico; Bazzoli, Franco

doi:10.1136/gut.2007.145177

Cited by 415 publications

(315 citation statements)

References 29 publications

(35 reference statements)

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“…BE has been detected in ∼ 15% of patients with chronic GERD ( 26 ) and in ∼ 1-2% of population subjects ( Table 2 ) ( 27,28 ). In a population-based study from Sweden, the authors found that severe and chronic GERD were risk factors for the development of EAC; however, 40% of the cohort with esophageal cancer reported no prior history of GERD symptoms ( 29 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,317

1,387

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Recent population studies suggest that gastroesophageal refl ux disease (GERD) is increasing in prevalence, both in the United States and worldwide ( 1,2 ). Th e diagnosis of GERD is associated with a 10-15% risk of Barrett's esophagus (BE), a change of the normal squamous epithelium of the distal esophagus to a columnar-lined intestinal metaplasia (IM). Risk factors associated with the development of BE include long-standing GERD, male gender, central obesity ( 3 ), and age over 50 years ( 4,5 ). Th e goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma (EAC), a malignancy that has been increasing in incidence since the 1970s ( 6,7 ).Th e purpose of this guideline is to review the defi nition and epidemiology of BE, available screening modalities for BE detection, rationale and methods for surveillance, and available treatment modalities including medical, endoscopic, and surgical techniques. In order to evaluate the level of evidence and strength of recommendations, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system ( 8 ). Th e level of evidence ranged from "high" (implying that further research was unlikely to change the authors' confi dence in the estimate of the eff ect) to "moderate" (further research would be likely to have an impact on the confi dence in the estimate of eff ect) to "low" (further research would be expected to have an important impact on the confi dence in the estimate of the eff ect and would be likely to change the estimate) or "very low" (any estimate of eff ect is very uncertain). Th e strength of a recommendation was graded as "strong" when the desirable eff ects of an intervention clearly outweighed the undesirable eff ects and as "conditional" when there was uncertainty about the tradeoff s. We used meta-analyses or systematic reviews when available, followed by clinical trials and cohort and case-control studies. In order to determine the level Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with refl ux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-defi nition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is ...

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Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,317

1,387

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“…In a Swedish prospective study by Ronkainen et al (5), an upper endoscopy was performed on a random sample of 1000 adults, detecting BE in 16 individuals (1.6%), of whom only 5 were considered o have LSBE (0.5%). Similarly, population-based studies from Italy and China showed a BE prevalence of 1.3% and 1.9%, respectively (7,8). On the other hand, in a prospective study that included 961 colonoscopy patients (mean age=-59 years) who underwent additional EGD, an overall BE prevalence of 6.8% was observed, with the majority (5.5%) having SSBE in those aged 40 years or more irrespective of any previous episodes of heartburn (9).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Barrett's esophagus in Lebanon

Masri

Ibrahim²,

Badreddine³

et al. 2015

Turk J Gastroenterol

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Background/Aims: To determine the prevalence of Barrett's Esophagus (BE) in a tertiary care center in Lebanon and to compare IT with regional and global data. Materials and Methods: All esophagogastroduodenoscopies (EGDs) performed between January 2003 and October 2013 at the American University of Beirut Medical Center (AUBMC) were reviewed, and cases of endoscopically suspected esophageal metaplasia (ESEM) were identified. Definite BE was considered only if histologically proven intestinal metaplasia was present. Results: Totally, 16,787 patients underwent EGD; 219 patients (1.3%) were labeled as having ESEM. Only 41 patients had biopsyproven BE (18.7% of ESEM and 0.24% of total patients). The mean age of the patients with BE was 58.1 years [Standard deviation (SD) =13.7] and 78% were men. Of the 41 patients, 14 (34.1%) had long-segment BE (LSBE) (>3 cm) while 27 had short segment Barrett's Esophagus (SSBE) (≤3 cm). Hiatal hernia was identified in 54% of the patients, more commonly in those with LSBE. Only four patients had low-grade dysplasia, and none had high-grade dysplasia. Conclusion: The prevalence of BE in Lebanon is much lower than that in Western countries. The reasons for this East-West divide are unknown and require further investigation.

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“…However, despite these limitations, our findings are in accordance with population-based studies from various Western nations. 3,7,18,24,[34][35][36] In summary, there are marked differences in the country specific prevalence of UGI complaints. These differences are associated with socioeconomic indicators such as the GDP per capita.…”

Section: Discussionmentioning

confidence: 99%