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George Triadafilopoulos

Publications and source records attributed to George Triadafilopoulos.

At least 37 records · Page 2Linked to original sources
PubMed2005

Patient-derived health state utilities for gastroesophageal reflux disease.

BACKGROUND AND AIMS: Gastroesophageal reflux disease is a chronic disease that adversely affects health-related quality of life. The purpose of this study was to derive health state utilities for patients with chronic heartburn symptoms. METHODS: We used a custom-designed computer program in order to elicit utilities with the time-tradeoff and standard-gamble techniques. Patients with chronic (more than 6 months) symptoms of gastroesophageal reflux disease entered the study. Two interviews were performed in random sequence either initially on medications for heartburn that adequately controlled symptoms, or off of medications for 1 wk while the patient was symptomatic. We also collected data using visual-analog scales, quality of life in reflux and dyspepsia (QOLRAD), and Gastrointestinal Symptom Rating Scale (GSRS) scores. RESULTS: We invited 222 patients to participate; 158 (71%) patients (129 men, 29 women) completed the study. Barrett's esophagus was present in 40 (25%), erosive disease in 17 (11%), and 118 (74%) had comorbid conditions. The mean (+/-SD) utility ratings were 0.94 +/- 0.09 on medical therapy and 0.90 +/- 0.12 off medications for patients with reflux alone using time tradeoff (p= 0.004), and 0.94 +/- 8.0 both on and off of antireflux medications with standard-gamble assessment (p= 0.96). Mean time-tradeoff scores were also significantly lower off of medications for patients with other comorbid conditions (p= 0.002). There was no significant difference between mean utility scores for patients with or without Barrett's esophagus or erosive disease. CONCLUSION: Gastroesophageal reflux disease adversely affects health-related quality of life. Time-tradeoff utility for patients with reflux disease is substantially higher when patients are on medication than off medications.

Adult↗
PubMed2005

Patterns of use and public perception of over-the-counter pain relievers: focus on nonsteroidal antiinflammatory drugs.

OBJECTIVE: To assess the frequency and indications for over-the-counter (OTC) nonsteroidal antiinflammatory drug (NSAID) use and to what degree the public is aware of their side effects. METHODS: Two surveys totaling 9062 respondents were performed of the American public. The Roper survey, conducted in 1997, and the National Consumers League (NCL) survey, conducted in December 2002, were intended primarily to assess the public's use of and attitudes toward NSAID and OTC analgesics. RESULTS: Ibuprofen based drugs were the most frequently used OTC in both surveys (57% Roper, 33% NCL). In the Roper survey, 17% of respondents used NSAID, with 38% using both prescription and OTC. Forty-six percent of exclusive OTC users believed OTC were safer, while 56% of exclusive users of prescription NSAID believed they were safer. Sixty percent and 29% of exclusive OTC users were neither aware of nor believed they were at risk for side effects from NSAID, respectively. Twenty-six percent of respondents used more than the recommended dose on the label, while 22% believed warning symptoms would always precede any NSAID induced complications. In the NCL survey, 83% had used an OTC agent in the last year, with 15% reporting daily use, and 49% were not concerned about potential side effects. In this survey, 30% believed there was less risk with OTC analgesics, and 44% consumed more than the recommended dosage on the label. CONCLUSION: OTC analgesics including NSAID are widely used, are frequently taken inappropriately and potentially dangerously, and users are generally unaware of the potential for adverse side effects. Educational intervention directed toward both patients and physicians appears warranted.

Acetaminophen↗
PubMed2004

Risk of serious upper gastrointestinal and cardiovascular thromboembolic complications with meloxicam.

PURPOSE: To assess the risk of serious gastrointestinal and thromboembolic complications with approved doses of meloxicam. METHODS: We pooled data from clinical trials of meloxicam at doses of 7.5 or 15 mg/d. A blinded gastrointestinal adjudication committee used prespecified criteria to identify gastric or duodenal perforation, gastric outlet obstruction, or hemodynamically important upper gastrointestinal bleeding. For analysis of thromboembolic complications, investigator-reported events were analyzed without adjudication. RESULTS: We analyzed data from 24,196 patients from 28 trials, most of whom had been followed for up to 60 days. Of these patients, 13,118 received meloxicam (10,158 received a daily dose of 7.5 mg and 2960 received 15 mg), 5283 were treated with diclofenac 100 mg, 181 received diclofenac 150 mg, 5371 were treated with piroxicam 20 mg, and 243 received naproxen 500 mg twice daily. Patients who received 7.5 mg of meloxicam daily had a 0.03% risk of serious upper gastrointestinal events, which was significantly lower than the risk in those who received diclofenac, naproxen, or piroxicam (P <0.02). With the 15 mg daily dose of meloxicam, this risk was significantly different only when compared with piroxicam (P = 0.03). The risk of thromboembolic events in patients treated with meloxicam at either dose was lower than with diclofenac, but similar to that observed with piroxicam and naproxen. CONCLUSION: This pooled analysis of 24,196 patients demonstrates that meloxicam has a favorable gastrointestinal and thromboembolic safety profile. However, only a small number of patients were followed for more than 60 days, and meaningful comparisons were not possible in this subgroup.

Adolescent↗
PubMed2004

The management of anticoagulants in the periendoscopic period for patients with atrial fibrillation: a decision analysis.

PURPOSE: The management of patients who undergo endoscopy while being treated with warfarin is challenging. We used decision analysis to determine the preferred strategy to manage anticoagulants in the periendoscopic period. METHODS: We designed a Markov model to estimate costs and quality-adjusted survival during a 10-year period in patients with nonvalvular atrial fibrillation undergoing screening colonoscopy. We compared six alternatives to the continue-warfarin strategy, which was to perform colonoscopy while the patient was taking full-dose warfarin. The hold-warfarin strategy was to stop warfarin 5 days before the colonoscopy. The repeat endoscopy strategy was to continue warfarin for a diagnostic colonoscopy, followed by a repeat procedure after cessation of warfarin if polypectomy was required. The dose-reduction strategy was to reduce the warfarin dose before colonoscopy. The low molecular weight heparin strategy was to administer subcutaneous low molecular weight heparin for 2 days before and 2 days after colonoscopy. The unfractionated heparin strategy was to administer intravenous unfractionated heparin for 2 days before and 2 days after the procedure. The vitamin K strategy was to hold warfarin for 4 days and to administer vitamin K if the international normalized ratio (INR) exceeded 2.0 the day before the procedure, or low molecular weight heparin if the INR was less than 1.5. RESULTS: For screening colonoscopy, assuming that polyps would be removed in 35% of examinations, the hold-warfarin and dose-reduction arms were both cost-effective strategies. The hold-warfarin arm was most cost-effective if the likelihood of polypectomy exceeded 60%, or if there was a low risk of stroke despite atrial fibrillation. The continue-warfarin strategy was preferred if the probability of polypectomy was 1% or less. CONCLUSION: Temporary warfarin cessation or halving the warfarin dose for several days before endoscopy was the preferred strategy for most patients. Periendoscopic heparin therapy was not cost-effective for patients with nonvalvular atrial fibrillation.

Aged↗
PubMed2004

Cost-effectiveness of photodynamic therapy for high-grade dysplasia in Barrett's esophagus.

BACKGROUND: Photodynamic therapy appears to be effective in ablating high-grade dysplasia in Barrett's esophagus. Our aim was to identify the most effective and cost-effective strategy for managing high-grade dysplasia in Barrett's esophagus without associated endoscopically visible abnormalities. METHODS: By using decision analysis, the lifetime costs and benefits of 4 strategies for which long-term data exist were estimated by us: esophagectomy, endoscopic surveillance, photodynamic therapy, followed by esophagectomy for residual high-grade dysplasia; and photodynamic therapy followed by endoscopic surveillance for residual high-grade dysplasia. It was assumed by us that there was a 30% prevalence of cancer in high-grade dysplasia patients and a 77% efficacy of photodynamic therapy for high-grade dysplasia and early cancer. RESULTS: Esophagectomy cost 24,045 dollars, with life expectancy of 11.82 quality-adjusted life years. In comparison, photodynamic therapy followed by surveillance for residual high-grade dysplasia was the most effective strategy, with a quality-adjusted life expectancy of 12.31 quality-adjusted life years, but it also incurred the greatest lifetime cost (47,310 dollars) for an incremental cost-effectiveness of 47,410 dollars/quality-adjusted life years. The results were sensitive to post-surgical quality of life and survival, and to cancer prevalence if photodynamic therapy efficacy for cancer was less than 50%. CONCLUSIONS: Photodynamic therapy followed by endoscopic surveillance for residual high-grade dysplasia appears to be cost effective compared with esophagectomy for patients diagnosed with high-grade dysplasia in Barrett's esophagus. Clinical trials directly comparing these strategies are warranted.

Adenocarcinoma↗
PubMed2004

Cost-effectiveness model of endoscopic screening and surveillance in patients with gastroesophageal reflux disease.

BACKGROUND & AIMS: Endoscopic screening and periodic surveillance for patients with Barrett's esophagus has been shown to be cost-effective in patients with esophageal dysplasia, with treatment for esophageal cancer limited to esophagectomy. Most gastroenterologists refer patients with high-grade dysplasia for esophagectomy, and effective endoscopic therapies are available for nonoperative patients with esophageal cancer. The cost-effectiveness of screening strategies that incorporate these nonsurgical treatment modalities has not been determined. METHODS: We designed a Markov model to compare lifetime costs and life expectancy for a cohort of 50-year-old men with chronic reflux symptoms. We compared 10 clinical strategies incorporating combinations of screening and surveillance protocols (no screening, screening with periodic surveillance for both dysplastic and nondysplastic Barrett's esophagus, or periodic surveillance for dysplasia only), treatment for high-grade dysplasia (esophagectomy or intensive surveillance), and treatment for cancer (esophagectomy or surgical and endoscopic treatment options). RESULTS: Screening and surveillance of patients with both dysplastic and nondysplastic Barrett's esophagus followed by esophagectomy for surgical candidates with high-grade dysplasia or esophageal cancer and endoscopic therapy for cancer patients who were not operative candidates cost $12,140 per life-year gained compared to no screening. Other screening strategies, including strategies that had no endoscopic treatment options, were either less effective at the same cost, or equally effective at a higher cost. CONCLUSIONS: The cost-effectiveness of screening and subsequent surveillance of patients with dysplastic as well as nondysplastic Barrett's esophagus followed by endoscopic or surgical therapy in patients who develop cancer compares favorably to many widely accepted screening strategies for cancer.

Adenocarcinoma↗
PubMed2004

Communicating with patients with inflammatory bowel disease.

Ulcerative colitis and Crohn's disease, the two main forms of inflammatory bowel disease (IBD), are chronic illnesses that affect hundreds of thousands of Americans. Patients with IBD suffer chronically from diarrhea, abdominal pain, gastrointestinal bleeding, malabsorption, and weight loss requiring continuous medical and surgical attention. Despite recent advances in therapy, IBD follows a course of exacerbations and remissions with approximately 25-50% of patients relapsing annually. Hence, these diseases are readily encountered in primary care and gastroenterology clinics. Though medical and surgical treatment options have improved significantly, little has been written about the psychosocial aspects of IBD. Currently, there is a paucity of data concerning effective communication methods enabling physicians to develop stronger rapport with patients suffering from IBD, the care of whom requires a multidisciplinary approach involving primary care physicians, gastroenterologists, and colorectal surgeons. Because IBD has a high morbidity, it is worthwhile to further investigate those social factors that will improve patients' quality of life. In this paper, we summarize some of the common problems that emerge when taking care of patients with IBD and provide initial guidelines based on the world literature regarding the management and education of patients with IBD. Both primary care physicians and specialists (gastroenterologists, colorectal surgeons) need to be aware of the questions and concerns of IBD patients and to be capable of dispensing the information in a clear and concise manner. Using the case scenario format, we review the most common aspects of communication for health care professionals taking care of IBD patients and suggest ways to establish and maintain long-term doctor-patient relationships. The two most significant interventions that dramatically improve quality of life and patient-physician relationships are proper patient education and appropriate treatment of concurrent depression and anxiety. We hope that our review will form a framework by which different members of the medical team learn their roles in the complex management decisions affecting IBD patients.

Adult↗
PubMed2004

Features of gastroesophageal reflux disease in women.

OBJECTIVES: Gastroesophageal reflux disease (GERD) is as common in women as in men, and may present with various symptoms, such as heartburn, regurgitation, dysphagia, or chest pain. In this study, we evaluated the patterns of symptomatic GERD and the spectrum of disease activity in women and compared them to a cohort of disease- and age-matched men. METHODS: We studied 543 adults, both men and women, referred for evaluation because of symptoms or signs suggestive of GERD. All patients were assessed immediately before testing using a standardized symptom questionnaire. Endoscopic, ambulatory pH, and motility findings were categorized and graded according to their extent and severity. The prevalence, nature, and severity of esophageal symptoms and their relationship to endoscopic disease severity were then analyzed. Comparisons were made between the two groups, i.e., 341 men (mean age 54, age range 25-90) and 202 women (mean age 50, age range 22-80). RESULTS: Heartburn without esophagitis was noted in 38% of men and 55% of women patients. Hiatal hernia was noted in 28% of men and in 26% of women. There were no differences in the magnitude of esophageal acid exposure by pH criteria and motility abnormalities between the two groups. The prevalence of endoscopic stages of GERD (0-IV, Savary-Miller classification) was similar between the two groups (p > 0.1, chi2 test) but women were less likely to harbor Barrett's esophagus (p < 0.05, chi2 test). Quantitative esophageal symptom analysis revealed significantly higher symptom severity scores for heartburn (p < 0.01), regurgitation (p < 0.05), belching (p < 0.01), and nocturnal (p < 0.01) symptoms in women as compared to men. Women also experienced higher symptoms scores of lower abdominal symptoms, such as abdominal pain, diarrhea, and constipation (p < 0.01). CONCLUSIONS: Among symptomatic adults undergoing evaluation for GERD, women appear to have generally similar patterns of endoscopic severity of GERD as men but they are less likely to harbor Barrett's esophagus. The severity of symptoms in women is significantly more than in men and may contribute to earlier disease recognition and different disease management.

Abdominal Pain↗
PubMed2004

Complete elimination of reflux symptoms does not guarantee normalization of intraesophageal and intragastric pH in patients with gastroesophageal reflux disease (GERD).

BACKGROUND: Acid plays a significant role in the development of gastroesophageal reflux symptoms, such as heartburn and regurgitation. It is generally assumed that acid suppressive therapy improves or eliminates symptoms by normalizing intraesophageal pH. AIMS: The aim of this article was to assess the efficacy of proton-pump inhibitors (PPIs) in normalizing intraesophageal and intragastric pH in patients with GERD without Barrett's esophagus (BE) rendered symptom free by therapy. METHODS: Patients were evaluated by dual-sensor 24-h pH monitoring while receiving PPI therapy for complete control of GERD symptoms. Analyses of intraesophageal and intragastric pH profiles were then made. RESULTS: Fifty patients, 39 men and 11 women, with GERD, without BE, were studied. All tolerated PPIs well and were asymptomatic at the time of the study. Fifty percent of patients had abnormal intraesophageal pH profiles despite adequate symptom control on PPIs, which was associated with significant breakthrough of intraesophageal acid control in both the upright and supine positions. Low intragastric pH correlated highly with intraesophageal acid reflux only in patients with persistent abnormal esophageal acid exposure (p= 0.001). CONCLUSIONS: Fifty percent of patients with GERD without BE continue to exhibit pathologic GERD and low intragastric pH despite PPI therapy that achieves complete reflux symptom control.

Cohort Studies↗
PubMed2004

GERD: the potential for endoscopic intervention.

Gastroesophageal reflux disease (GERD) is a common disorder that significantly affects patients' quality of life. Most patients with symptomatic GERD do not have erosive reflux disease. Frequent transient lower oesophageal sphincter relaxations and the presence of hiatal hernia have emerged as major and interacting factors in GERD. Several endoscopic anti-reflux therapies aiming at creating an anti-reflux barrier and reducing or eliminating the need for chronic medical therapy or fundoplication have been introduced and validated as feasible, safe and effective. Today, it is possible to manage GERD patients with a multioption approach of medical, endoscopic or surgical therapies according to the size of hiatal hernia, the lower esophageal pressure profile and their clinical response to single-modality therapy.

Decision Trees↗
PubMed2004

Antimicrobial resistance incidence and risk factors among Helicobacter pylori-infected persons, United States.

Helicobacter pylori is the primary cause of peptic ulcer disease and an etiologic agent in the development of gastric cancer. H. pylori infection is curable with regimens of multiple antimicrobial agents, and antimicrobial resistance is a leading cause of treatment failure. The Helicobacter pylori Antimicrobial Resistance Monitoring Program (HARP) is a prospective, multicenter U.S. network that tracks national incidence rates of H. pylori antimicrobial resistance. Of 347 clinical H. pylori isolates collected from December 1998 through 2002, 101 (29.1%) were resistant to one antimicrobial agent, and 17 (5%) were resistant to two or more antimicrobial agents. Eighty-seven (25.1%) isolates were resistant to metronidazole, 45 (12.9%) to clarithromycin, and 3 (0.9%) to amoxicillin. On multivariate analysis, black race was the only significant risk factor (p < 0.01, hazard ratio 2.04) for infection with a resistant H. pylori strain. Formulating pretreatment screening strategies or providing alternative therapeutic regimens for high-risk populations may be important for future clinical practice.

Adolescent↗
PubMed2003

Stretta: an effective, minimally invasive treatment for gastroesophageal reflux disease.

The Stretta procedure is increasingly offered as first-line therapy before more invasive surgical procedures for selected patients with gastroesophageal reflux disease (GERD). Although a new addition to the clinical armamentarium, thus far the Stretta procedure appears to be a safe and effective technology for the treatment of GERD, with well-documented clinical trial data supporting its efficacy, safety, and patient satisfaction.

Clinical Trials as Topic↗
PubMed2003

Use of a colonoscope instead of a sigmoidoscope to screen asymptomatic adults for colorectal cancer.

BACKGROUND: Colonoscopic screening can detect neoplasms in asymptomatic adults, many of which would not be detected by sigmoidoscopy. However, because of cost and resource factors, many adults still undergo flexible sigmoidoscopy for colorectal cancer screening. In asymptomatic adults over age 50 undergoing unsedated flexible sigmoidoscopy screening, use of a colonoscope instead of a sigmoidoscope was studied to determine the feasibility, safety, tolerability, and yield. METHODS: Over an 18-month period, asymptomatic adults referred for colorectal cancer screening by sigmoidoscopy were enrolled. Two experienced nurses attempted to reach the cecum by using a pediatric colonoscope but stopped if significant discomfort was experienced, if the preparation was suboptimal, or if polyps were found. RESULTS: A total of 672 adults (652 men, 20 women) underwent screening. The colonoscope was advanced beyond the level attainable with a sigmoidoscope (70-cm mark) in 240 cases. The cecum was reached in 110 (16.4%) of these patients, with a mean pain intensity for patients of 2.6 (scale 1-10) and a mean time for completion of the procedure of 17 minutes. Colonoscopy to the cecum was not feasible because of patient discomfort in 280 patients (41.7%), poor preparation in 179 (26.7%), left-sided polyps or cancer in 69, and/or severe diverticulosis and tortuosity in 34 cases. Twenty patients had polyps proximal to the 70-cm mark (65% adenomas, no cancer). There was no complication. CONCLUSIONS: The use of a colonoscope instead of a sigmoidoscope by nurses performing unsedated screening sigmoidoscopy is feasible, safe, and well-tolerated, and may improve the yield for screening by at least 16.4% in patients who would otherwise have had only the left colon examined.

Aged↗
PubMed2003

Clinical experience with the Stretta procedure.

The benchmarks in GERD therapy comprise the commonly prescribed anti-secretory drugs (H2RAs and PPIs) and anti-reflux surgery. Although drugs are typically safe, cost and patient compliance are challenges to long-term management. Furthermore, while heartburn may be controlled with aggressive medical therapy, other symptoms such as regurgitation may persist, reducing patient satisfaction and adversely affecting quality of life. Surgical anti-reflux procedures, most commonly laparoscopic Nissen fundoplication, improve GERD symptoms and normalize esophageal acid exposure in most patients. Patient perception of the potential risk of abdominal surgery and general anesthesia may limit willingness to undergo surgery resulting in only a small portion of GERD sufferers that actually undergo anti-reflux surgery each year. Overall, the Stretta procedure is well tolerated, with an acceptably low incidence of complications and obviates the need for anti-secretory drug therapy for most patients at the 6- and 12-month follow-up. GERD symptom scores, heartburn, satisfaction, and SF-36 scores significantly improve over the baseline and this effect lasts at least 12 months. The symptomatic improvement after Stretta at 12 months in one trial (GERD score, 27 to 9) is similar to that reported by Velanovich after fundoplication (GERD score, 27 to 3). Furthermore, the significant reduction in median esophageal acid exposure time (distal 10.6% to 6.2%, proximal 1.9% to 0.9%), provides objective evidence of an anti-reflux effect. Although the reported studies have been non-randomized, the objective improvement observed in esophageal acid exposure and the persistence of GERD symptom score improvement with repeated measure analysis over a course of 12 months make a significant placebo effect unlikely. Stretta is a promising new technology for the treatment of GERD that should be considered for patients who wish to discontinue a lifelong anti-secretory medication regimen or who have incomplete GERD symptom control on drugs, but are not yet accepting anti-reflux surgery.

Catheter Ablation↗
PubMed2003

Exercise and gastrointestinal function and disease: an evidence-based review of risks and benefits.

BACKGROUND & AIMS: Exercise is beneficial to health because it reduces the risk of cardiovascular and endocrine diseases, improves bone and muscle conditioning, and lessens anxiety and depression. However, the impact of exercise on the gastrointestinal system has been conflicting. This systematic literature review evaluates the effect of the different modes and intensity levels of exercise on gastrointestinal function and disease using an evidence-based approach. Although more applicable to trained athletes and individuals who are highly active and, as such, at risk to experience the side-effects of exercise, an effort was made to state the level or degree of exercise or the lack of such evidence. RESULTS: Light and moderate exercise is well tolerated and can benefit patients with inflammatory bowel disease and liver disease. Physical activity can also improve gastric emptying and lower the relative risk of colon cancer in most populations. Severe, exhaustive exercise, however, inhibits gastric emptying, interferes with gastrointestinal absorption, and causes many gastrointestinal symptoms, most notably gastrointestinal bleeding. CONCLUSIONS: This knowledge will enable physicians to prescribe physical exercise in health and disease and to better manage patients with exercise-related gastrointestinal disorders. Our understanding of exercise and its gastrointestinal manifestations as well as risks and benefits warrants further investigation.

Digestive System↗
PubMed2003

Belching: dyspepsia or gastroesophageal reflux disease?

OBJECTIVES: Eructation (belching) is a common symptom seen in clinical practice. Because either belching or heartburn may result from transient lower esophageal sphincter relaxations, it has been proposed that belching may be a manifestation of gastroesophageal reflux disease (GERD). In this retrospective study we evaluated the prevalence of belching in dyspepsia and GERD and the relation of belching to acid reflux events documented by pH monitoring. METHODS: We examined the prevalence, frequency, and severity of belching and other GERD symptoms by use of standardized questionnaires in 180 GERD patients (group A) and 78 dyspeptic controls (group B) referred for evaluation at our institution. GERD was defined as either endoscopic esophagitis (or Barrett's esophagus) or positive DeMeester score (>14.2) on pH monitoring or both. Dyspeptic patients had normal endoscopy and pH studies. We also analyzed the relationship of belching to acid reflux events during the 24-h period of pH studies. RESULTS: Of 180 GERD patients, 132 (70%) reported belching during pH monitoring, versus 63 of 78 dyspeptic patients (80%) (p = ns). Similarly, 163 of 180 GERD patients (90%) reported heartburn versus 64 of 78 of dyspeptic patients (82%) (p = ns). Review of symptom questionnaires revealed no significant difference in belching severity between groups. However, heartburn and acid regurgitation were significantly more severe among GERD patients. There was a significantly higher correlation of both heartburn and belching with acid events in patients with GERD compared with patients with dyspepsia. In addition, although both belching and heartburn were significantly improved in patients with GERD, belching scores remained unchanged after proton pump inhibitor (PPI) therapy in patients with dyspepsia. CONCLUSIONS: Belching is as common and as severe in patients with dyspepsia as it is in patients with GERD. Belching and heartburn in GERD patients are more likely correlated with episodes of pathological acid reflux. Because belching cannot be clinically used as a discriminatory symptom, ambulatory pH monitoring should be considered to elucidate the relationship of belching to acid reflux in patients with dyspepsia or GERD.

Case-Control Studies↗
PubMed2002

Screening for esophageal adenocarcinoma: an evidence-based approach.

Adenocarcinoma of the esophagus and the gastroesophageal junction is the twentieth most common malignancy in the United States. In developed countries, the incidence of esophageal adenocarcinoma is increasing 5% to 10% per year. Despite the use of endoscopy for earlier detection, mortality from esophageal adenocarcinoma has not declined. Using an evidence-based approach, we review screening methods for esophageal adenocarcinoma, including the use of a symptom questionnaire, identification of patients with a family history of Barrett's esophagus, peroral or transnasal endoscopy, barium swallow, fecal occult blood testing, and brush and balloon cytology. Screening has not been shown to reduce rate of progression of Barrett's esophagus to esophageal cancer. Many treatment options for dysplastic Barrett's esophagus or early carcinoma appear effective, but long-term follow-up data are not available. There is currently insufficient evidence supporting population-based screening for Barrett's esophagus. Several risk factors, including severe reflux symptoms, male sex, and obesity, may identify patients with gastroesophageal reflux disease who are at the greatest risk of the development of cancer.

Adenocarcinoma↗