Gastro esophageal reflux disease is the chief known etiologic factor for Barrette Esophagus, and BE is the precursor lesion of esophageal glandular cancer. The prevalence of BE is reported largely from gastroenterology centres and few informations are reported from outpatients with indigestion. Lots of patients with GERD have grades of indigestion. This survey chiefly aims to find the prevalence of BE in dyspeptic patients.
Material and methods: outpatients holding indigestion refer to endoscopy unit for endoscopy. Meanwhile the endoscopist takes biopsy of distal gorge. Barrett ‘s esophagus diagnosing will be find based on the endoscopic unnatural visual aspect of the distal gorge and besides based on Intestinal Metaplasia ( IM ) pathologic position.
Consequences: the prevalence of BE was 5.4 % ( based on endoscopy ) and 3.7 % ( base on pathology ) . 69 % of patients with confirmed BE were & gt ; 50 old ages and 31 % were & lt ; 50 old ages. 81 % of patients with confirmed BE reported GERD symptoms as their dominant indigestion symptom, but consequence is merely 20.4 % in patients without BE ( p value & lt ; 0.001 ) .
Decision: BE has a comparatively high prevalence in dyspeptic patients. The prevalence of GERD symptoms in BE emphasizes the demand for making endoscopy for dyspeptic patient.
Cardinal words: Barrett Esophagus, Endoscopy, Heartburn, Pathology
Prevalence of gastro esophageal reflux disease ( GERD ) is raising along with the prevalence of Barrett ‘s gorge ( BE ) and esophageal glandular cancer ( 1 ) . GERD is the chief known etiologic factor for BE, and BE is the precursor lesion of esophageal glandular cancer ( 2 ) . Adenocarcinoma of gorge is normally a locally turning tumour and it invades next variety meats and cause deadly complications ( 3 ) . BE is defined as altering the liner of distal gorge that can be recognized with endoscopy and is documented by presence of gablet cells and other standards for IM in biopsies taken during the endoscopy ( 4 ) . Hiatus hernia, fleshiness and presence of helicobacter pylori in gastro enteric piece of land are some of the hazard factors for BE ( 5, 6 ) . These factors are believed to increase BE by increasing acerb reflux. Many gastroenterologists make the diagnosing of BE by endoscopy and corroborate it with presence of IM in biopsies taken from the gorge ( 2 ) . The standard for endoscopy is the Presence of chronic GERD after ingestion of proton gaudery inhibitor or acerb suppressers for at least 4 hebdomads ( 7 ) . Association of BE with glandular cancer is the chief factor that thrust physicians to endoscopically measure GERD patients ( 8-11 ) . BE is found in 2 % of big population and 3-5 % of GERD patients ( 2 ) . The overall prevalence of BE in patients with chronic GERD is 3-12 % ( 8, 10, 11 ) .The prevalence of BE is reported largely from gastroenterology centres and few informations are reported from outpatients with indigestion. If we consider the coexistence of GERD with indigestion in many patients, the demand to measure dyspeptic patients for BE will be highlighted ( 10 ) .
This present study is aimed specifically to show the prevalence of BE in dyspeptic outpatients and to research possible hazard factors for its presence. It besides determines the efficaciousness of GI endoscopy to name BE in the selected population.
Material and methods:
This is a prospective survey on Outpatients of GI clinic who were over 18 old ages old and had a primary ailment of at least 3 months of indigestion ( intermittent or uninterrupted ) and have been conducted during 2007-2011, after the approve of Kashan University of medical Sciences Ethic commission.
We defined dyspepsia as composite of uncomfortableness or hurting in epigastric part ( with or without acerb regurgitation ) , inordinate belch or belching, abdominal bloating, early repletion or feeling of unnatural or slow digestion or pyrosis ( 10 ) . Patients who had a documented history of upper GI surgery, a clinical probe of indigestion by endoscopy or radiology ( in the old 6 months ) or on more than two occasions in the past 10 old ages, and used proton pump inhibitors within 30 yearss or H2-receptor adversaries within 14 yearss of registration excluded from the survey.
Out of the outpatients enroll ; those who consented orally to an endoscopy enter our survey, and refer to endoscopy unit of shahid beheshti infirmary, a cardinal infirmary in Kashan. Of the enrolled outpatients, informations on age, sex, nationality, weight and tallness, presence and laterality of GERD symptoms and continuance of dyspeptic symptoms will be record in separate signifier.
The presence of BE will measure in two ways: endoscopically, and histologically. Barrett ‘s esophagus diagnosing will be made based on the endoscopic unnatural visual aspect of the distal gorge. If there was a intuition of Barrett ‘s epithelial tissue in the distal of the gorge, the endoscopist find the instance as Barrett ‘s gorge and we mark the instance as BE instance by endoscopy. The presence of “ gastric-appearing mucous membrane ” or “ columnar-lined ” gorge is the standards for the endoscopist study of BE. The lengths of the unnatural epithelial tissue were non recorded. Biopsies from all instances were taken merely proximal to the gastro-esophageal junction, harmonizing to standard pattern for histological verification meanwhile the process. The determination of the figure of biopsies to be taken was made upon the estimate of Barrett ‘s epithelial tissue length by the endoscopist. If groundss of IM were seen in the biopsies by the diagnostician, BE could be confirmed, and we mark the instance as BE instance by pathology. These informations will be added to the patient ‘s signifier.
Data enter SPSS package and analyze with descriptive statistics, qis square trial and t-test.
Of the 1156 outpatients enrolled, 12 patients did n’t consent to hold endoscopy. Out of these 12 patients 9 were afghanian who had n’t return to hold endoscopy for unknown grounds. 3 of Persian patients did n’t accept to endoscopy and establish endoscopy unneeded, although the physician explained the necessity. A sum of 1144 dyspeptic patients underwent endoscopy, 1100 ( 96.2 % ) of them were Persian and 44 ( 3.8 % ) were afghanian. The average age of the instances was 45.2 old ages old. BE was endoscopically diagnosed in 62 instances ( 5.4 % ) , and pathologically diagnosed in 42 ( 3.7 % ) of them. All these 42 instances were diagnosed with endoscopy as BE, but 20 instances ( 32.2 % ) that were endoscopically marked BE, were non confirmed as BE by pathology. Thus the sensitiveness of endoscopy for diagnosing of BE is 100 % but its specificity is 67.8 % . The average age of patients with confirmed BE was 53.2 old ages. 42.6 % of patients without BE were male and 57.4 % were female whereas 64.3 % of patients with BE were male and 35.7 were female ( p value=0.005 ) table1.
Hiatus hernia was diagnosed in 10.2 % of all patients ( 117 out of 1144 ) . 9.1 % of patients without IM had Hiatus hernia, while 40.5 % of the patients with IM had Hiatus hernia ( p value & lt ; 00.1 ) ( table 2 ) .
54.8 % of the patients with BE had reflux esophagitis but merely 4.4 % of the patients without BE had reflux esophagitis ( p value=0.003 ) .
The average continuance of dyspeptic symptoms in the 42 BE patients was 10.29 old ages ; 6 patients ( 14.3 % ) reported symptoms & lt ; 5 old ages in continuance and 1 ( 2.4 % ) reported symptoms & lt ; 1 twelvemonth in continuance. Comparision of patients with and without BE revealed that patients with BE have longer period of indigestion ( P value & lt ; 0.01 ) ( table 2 ) .
Among 1144 patients 314 ( 27.4 % ) had acid regurgitation or pyrosis and 259 had these symptoms as their dominant symptom. Out of These 259, 34 ( 13.1 % ) had BE. 34 out of the 42 patients ( 81 % ) with confirmed BE reported either pyrosis or acerb regurgitation as their most bothersome ( dominant ) indigestion symptom, compared with 225 ( 20.4 % ) of the 1102 patients without BE ( p value & lt ; 0.001 ) ( table 2 ) .
The average BMI among all 1140 patients was 28.8 and there were no important difference between patients with confirmed BE and patients without BE ( p value=0.995 ) .
The recognized method for naming BE is detecting IM in biopsies taken from the gorge. There is a argument whether presence of stomachic metaplasia ( without IM ) should sort a patient as holding BE or non. In this survey, presence of IM in pathology is the cardinal point to sort a patient to hold BE.
In 1144 uninvestigated indigestion outpatients that undergone endoscopy, the prevalence of BE was 5.4 % if based on the endoscopic intuition of stomachic metaplasia in the distal gorge and 3.7 % when the diagnosing was histologically confirmed by the presence of IM. In one Single centre survey on 1248 Persian GERD patients, the prevalence of endoscopicaly suspected and pathologically confirmed BE was 8.3 % and 2.4 % severally ( 12 ) . But we investigated dyspeptic patients non GERD. The prevalence of BE among the patients that have acid regurgitation and pyrosis ( GERD symptoms ) as their dominant symptom is 13.1 % in our survey and is comparatively higher than old Persian probes ( 12, 13 ) . And is besides higher than 3-12 % in other surveies ( 8, 10, 11 ) . But our consequences are less than 24.1 % reported in a survey conducted in Japan ( 14 ) . As other surveies suggested ( 15 ) HH and esophagitis were more common in patients with BE and BE was more prevailing in males and older ages. In our survey people proposing pyrosis or acerb regurgitation tend to hold BE more than other surveies. In a survey by Breslin et Al. that reported on the findings of endoscopy in 3634 Canadian patients, the prevalence of BE suspected on endoscopy varied from 0.3 % to 2 % . And merely a minority ( 0.3 % ) was histologically confirmed ( 16 ) . This may be reflect the prevalence of BE in our country. In our survey 67 % of the endoscopically diagnosed BE were confirmed by histology. This rate is 11 % in another survey ( 17 ) Reflecting the function of endoscopist experience in naming BE.
It has been shown that both longer continuance and badness of pyrosis are risk factors for the development of glandular cancer of the distal gorge. Patients with BE in the current survey reported dyspepsia symptoms of longer continuance and merely 14.3 % had symptoms for & lt ; 5 old ages. The fact that BE is a complication of longstanding GERD has been one of the chief grounds behind the recommendation for a ‘once in a life-time ‘ endoscopy in patients with GERD symptoms ( 10 ) .
In drumhead, the overall prevalence of histologically confirmed BE was 3.7 % in outpatients with indigestion. Patients with dominant symptoms of pyrosis, the prevalence of BE was 13.5 % . These informations should be used in the treatment about the demand for a one time in a life-time endoscopy in patients with dyspeptic symptoms. Our informations suggest that if endoscopy is recommended and should take topographic point at an older age ( such as age & gt ; 50 old ages ) and in patients with symptoms of & gt ; 5 old ages continuance as it will increase the output of diagnosing of BE.