The potential impact of contemporary developments in the management of patients with gastroesophageal reflux disease undergoing an initial gastroscopy
SB Salem | Y Kushner | V Marcus | S Mayrand | CA Fallone | AN Barkun
BACKGROUND: Recent developments may alter the approach to
patients presenting with gastroesophageal reflux disease (GERD)-like
symptoms. A newly proposed Montreal consensus definition of
Barrett's esophagus includes all types of esophageal columnar metaplasia,
with or without intestinal-type metaplasia. There is also increasing
recognition of eosinophilic esophagitis (EE) in patients with GERD-like
OBJECTIVE: To quantify the impact of these developments on a
multiphysician general gastroenterology practice in a tertiary care
METHODS: Medical charts of all patients having an initial gastroscopy
for GERD-like symptoms over a one-year period were reviewed
retrospectively, and audits of their endoscopic images and esophageal
biopsies were performed.
RESULTS: Of the 353 study participants, typical symptoms of heartburn
and acid reflux were present in 87.7% and 23.2%, respectively.
Less commonly, patients presented with atypical symptoms (eg, dysphagia
in 9.4%). At endoscopy, 26% were found to have erosive
esophagitis and 12% had endoscopically suspected esophageal metaplasia.
Histological evaluation was available for 65 patients. Ten of
the 65 biopsied patients (15%) met traditional criteria for Barrett's
esophagus (ie, exhibiting intestinal-type metaplasia), whereas 49 (75%)
fulfilled the newly proposed consensus definition of Barrett's esophagus.
Five patients (7.7%) met the study criteria for EE (more than
20 eosinophils per high-power field), four of whom had not been previously
CONCLUSIONS: Among patients presenting with GERD-like
symptoms, the prevalence of Barrett's esophagus may increase markedly
if the Montreal definition is adopted. In addition, growing awareness
of EE may lead to an increase in the prevalence of this diagnosis.
Prospective studies of the management implications of these findings