Health-related quality of life in patients with Barrett’s esophagus

Abstract

BackgroundGastroesophageal reflux disease (GERD) has become a major health problem globally, affecting patients’ health-related quality of life (HRQOL). Barrett’s esophagus (BE) is a precancerous lesion associated with GERD. BE patients might not only suffer from HRQOL losses by GERD but also face psychological distress due to the increased risk of developing cancer. However, the majority of patients in Asia have shorter BE segment which is different from the West. This study aimed to determine whether the HRQOL in BE patients were worse than in healthy referents in Taiwan.MethodsPatients who received referral esophagogastroduodenoscopy for various symptoms were evaluated for the existence of BE. Lesions were judged as endoscopically suspected esophageal metaplasia (ESEM) if they showed morphological resemblances to BE by endoscopy. The diagnosis of BE was confirmed by histology with intestinal metaplasia or gastric metaplasia based on the Montreal definition. The World Health Organization Quality of Life (WHOQOL-BREF) was administered to BE patients before treatment. For each BE patient, we selected 2 age-, sex-, educational background and municipality-matched healthy referents, sampled by simple randomization method from a national survey in Taiwan. Multiple linear regression models were constructed to control the potential confounders.ResultsA total of 84 patients diagnosed with BE were enrolled as BE group and then compared with 168 healthy referents. The BE group had significantly lower WHOQOL-BREF scores than those of healthy referents in the physical domain (P < 0.05) but higher scores in the environment domain (P < 0.05). In the physical domain, the BE group had significantly lower scores in various facets, including pain, discomfort, sleep and rest and dependence on medications or treatments. There was no significant difference in social and psychological domains between the BE group and healthy referents.ConclusionsBE patients suffer from poor sleep and rest and high dependence on medications, which significantly reduce their quality of life. Individual facets of each domain warrants a better clinical healthcare to improve quality of life of BE patients.

Health-related quality of life of subjects with Barrett's esophagus in a Chinese population

“…A recent study enrolling 84 BE cases in Taiwan found BE had significantly poor HRQoL, based on WHOQOL-BREF scores, compared with healthy controls. The difference existed in the physical domain, but not in the social or psychological domains [ 17 ]. However, the HROoL of each subgroup of BE patients, or the severity of coexisting GERD symptoms, were not evaluated in the above studies.…”

Dysplasia severity is associated with poor quality of life in patients with Barrett's esophagus referred for endoscopic eradication therapy

“…This is consistent with a previous cohort study by Chang et al, which found that patients with BE overall have a worse QOL compared to the general population. 19 A second prospective cohort study by Kulig et al described that the impairment in QOL among patients with BE to be similar to that of patients with GERD. 20 While chronic GERD is an important factor in the development of BE, patients with BE represent a unique subset of GERD patients.…”

Precision care for Barrett’s esophagus

“…Yet, frequently BE patients have insufficient understanding of the disease, inaccurate perceptions of cancer risk, and an unnecessary psychological burden, all amenable to clarification and better guidance (55). In a Taiwanese study, 84 BE patients were compared with 168 healthy adults and were found to have significantly lower QoL scores, particularly in pain, discomfort, sleep and rest and dependence on medications or treatments but there were no significant differences in social and psychological domains (56).…”