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Sa1074 Increased Number of Risk Factors Predicts Esophageal Injury and Metaplasia: Results From a Large Prospective Population-Based Study
AGA Abstracts
Patients who underwent EET with either EMR, RFA, APC, or a combination of these modalities were included in this analysis. Patients who stopped EET and started surveillance prior to CE-IM were excluded. Complete eradication of intestinal metaplasia (CE-IM) was defined as having an endoscopy with no visible columnar lined epithelium in the tubular esophagus and biopsies of the neo-squamous mucosa showing no intestinal metaplasia. Patients were considered to have achieved CE-IM if they had done so with < 5 EET sessions. Patients who had not yet achieved CE-IM but had received at least 4 EET sessions were considered to be still undergoing therapy. Results: 331 BE patients [mean age 65.2 (SD 12.0), 89.1% Male, 93.4% Caucasian, mean BE length 5.1cm (SD 6.4)] from 4 centers were included. Baseline histology was: LGD (n=42), HGD (n=158), and early cancer (n=131). 149 (45.0%) patients were still undergoing endoscopic therapy. Of the remaining 182 patients, 69 were treated with EMR only, 21 with endoscopic ablation only, and 92 with combination EMR + ablation therapy. Patients with C extents of > 2cm were less likely to achieve CE-IM compared to those with C extents £2cm (64.3% vs. 73.5%, p=0.027). Patients with M extents of > 3cm were less likely to achieve CE-IM compared to those with M extents £3cm (61.2% vs. 88.4%, p<0.001). Conclusions: Results of this multi-center effectiveness trial show that pre-treatment Barrett's esophagus extent as measured by the Prague criteria is associated with the rate of achieving CE-IM with endoscopic eradication therapy. This was true for both the C and M extents of disease. This study provides the first validation of the Prague criteria with clinically relevant outcomes in the management of patients with Barrett's esophagus.
Graph 1. Risk of Esophageal injury and Metaplasia increases profoundly by presence of multiple risk factors. In comparison to group 0-1, group 2-3 [OR 2.9 (95% CI 1.1, 13.6; p<0.05)] and group 4-6 [OR 6.7 (95% CI 1.6, 26.6; p<0.05)] had significantly increased risk.
Sa1075 Sa1074 Volatile Organic Compounds in Blood for Non-Invasive Diagnosis of Barrett's Esophagus - A Pilot Study Amit Bhatt, Mansour A. Parsi, Scott L. Gabbard, Arthi Kumaravel, David Grove, Sunguk Jang, Tyler Stevens, Murthy C. Sudish, Gregory Zuccaro, John J. Vargo, Raed A. Dweik
Increased Number of Risk Factors Predicts Esophageal Injury and Metaplasia: Results From a Large Prospective Population-Based Study Nicholas R. Crews, Kelly T. Dunagan, Michele L. Johnson, Felicity Enders, Cathy D. Schleck, Louis M. Wong Kee Song, Kenneth K. Wang, David A. Katzka, Prasad G. Iyer
Background: Endoscopic surveillance of Barrett's esophagus (BE) is effective for detecting esophageal dysplasia and cancer at an early and curable stage. Unfortunately, most patients diagnosed with EAC are not identified in a BE screening program and have advanced disease. Therefore, an easy and non-invasive blood or breath test to detect BE may help get more patients into endoscopic surveillance. Breath testing is an ideal non-invasive test that detects volatile organic compounds (VOCs) that diffuse from the body into the lungs. To identify potential breath and blood makers, we compared VOCs in the headspace (gas above the sample) of whole blood from patients with BE without prior treatment and those with gastroesophageal reflux disease (GERD) and no BE. Methods: Blood samples were collected prior endoscopy. Samples were frozen (-80°C) within 30 minutes of collection until the time of analysis. The samples were heated to 40°C to allow the VOCs in the headspace to come into equilibrium with the sample. 20 milliliters of headspace was removed and analyzed to determine the concentration of 22 pre-selected VOCs that are most commonly found in breath. Results: The headspaces from 16 blood samples (6 GERD and 10 BE) were analyzed. Isoprene levels were significantly higher in the headspace of patients with BE compared to those with GERD (11.6, 8.9 (P<0.039)) (Figure 1) Isoprene identified patients with BE with an AUCROC 0.82 (95% CI: 0.59,1.00). (Figure 2) Other VOCs analyzed were not differentially expressed in BE. Conclusion: Measurement of volatile isoprene in blood may identify patients with BE non-invasively. Studies are ongoing to validate these results and determine if isoprene measurement in blood and breath can help detect BE in patients with long standing reflux.
BACKGROUND AND AIMS Screening for Barrett's esophagus (BE) has historically focused on the presence of individual risk factors, particularly chronic gastroesophageal reflux (GERD) symptoms, sex, age, and central obesity. Society guidelines recommend screening in subjects with multiple risk factors. A positive correlation between the prevalence of BE and the number of risk factors has been assumed. Risk stratification based on the increased number of existing risk factors is not well studied. This study aimed to assess whether the number of risk factors can serve as a clinical tool to predict the likelihood of esophageal injury and metaplasia. DESIGN AND METHODS Olmsted county, MN residents aged 50 or older without known BE or recent endoscopy were recruited for a randomized, populationbased study investigating the efficacy of novel endoscopic screening methods. Subjects were stratified by age, sex, and GERD symptoms. Anthropometric measurements and validated GI symptom questionnaire responses were obtained. From this comprehensive, prospective data set, the number of risk factors was assessed for each subject. Six equally-weighted factors were included: male sex, age > 75 years, GERD, ever tobacco use, family history of BE or esophageal cancer and central obesity (waist-to-hip ratio (WHR) for males >0.94 and females >0.85). GERD was defined as heartburn, acid regurgitation or antacid use more than once a week or daily PPI use. Esophageal injury was defined as presence of BE and/ or esophagitis LA criteria grade B, C, or D. The risk of esophageal injury was analyzed for three groups (0-1, 2-3, or 4-6 factors present) using logistic regression. RESULTS Of the 205 residents who underwent endoscopic assessment, 38 (18.5%) subjects were found to have esophageal injury or metaplasia (esophagitis (33 total, 29 B, 4 C, 0 D) / BE (16)). 46% were male with a mean (SD) age of 70 (10) years. 33% of subjects had GER symptoms, and 98% were of Caucasian race. The rate of esophagitis/BE in the group with 0-1 risk factors was 6.1%, while the rate in group 2-3 and group 4-6 was significantly greater at 20% and 30%, respectively (p<0.05). Male sex and central obesity were independent risk factors, while age > 75 trended to, but did not reach statistical significance. The odds of esophagitis/BE was 2.9 times more (95% CI 1.1, 13.6; p<0.05) for group 2-3 compared to group 0-1. Presence of 4-6 factors had an odds of 6.7 (95% CI 1.6, 26.6; p<0.05) compared to group 0-1. CONCLUSION Esophagitis and BE are prevalent in the population. These results confirm the additive nature of risk factors, with risk appearing to increase substantially with 2 or more risk factors and likely continuing to rise as the number of factors increase. Male sex and central obesity were independent risk factors. Table 1. Risk Factors and their Associated Risk of Esophageal injury
Figure 1:{BR}ppb = parts per billion
* p < 0.05 considered significant
S-215
AGA Abstracts
Patients who underwent EET with either EMR, RFA, APC, or a combination of these modalities were included in this analysis. Patients who stopped EET and started surveillance prior to CE-IM were excluded. Complete eradication of intestinal metaplasia (CE-IM) was defined as having an endoscopy with no visible columnar lined epithelium in the tubular esophagus and biopsies of the neo-squamous mucosa showing no intestinal metaplasia. Patients were considered to have achieved CE-IM if they had done so with < 5 EET sessions. Patients who had not yet achieved CE-IM but had received at least 4 EET sessions were considered to be still undergoing therapy. Results: 331 BE patients [mean age 65.2 (SD 12.0), 89.1% Male, 93.4% Caucasian, mean BE length 5.1cm (SD 6.4)] from 4 centers were included. Baseline histology was: LGD (n=42), HGD (n=158), and early cancer (n=131). 149 (45.0%) patients were still undergoing endoscopic therapy. Of the remaining 182 patients, 69 were treated with EMR only, 21 with endoscopic ablation only, and 92 with combination EMR + ablation therapy. Patients with C extents of > 2cm were less likely to achieve CE-IM compared to those with C extents £2cm (64.3% vs. 73.5%, p=0.027). Patients with M extents of > 3cm were less likely to achieve CE-IM compared to those with M extents £3cm (61.2% vs. 88.4%, p<0.001). Conclusions: Results of this multi-center effectiveness trial show that pre-treatment Barrett's esophagus extent as measured by the Prague criteria is associated with the rate of achieving CE-IM with endoscopic eradication therapy. This was true for both the C and M extents of disease. This study provides the first validation of the Prague criteria with clinically relevant outcomes in the management of patients with Barrett's esophagus.
Graph 1. Risk of Esophageal injury and Metaplasia increases profoundly by presence of multiple risk factors. In comparison to group 0-1, group 2-3 [OR 2.9 (95% CI 1.1, 13.6; p<0.05)] and group 4-6 [OR 6.7 (95% CI 1.6, 26.6; p<0.05)] had significantly increased risk.
Sa1075 Sa1074 Volatile Organic Compounds in Blood for Non-Invasive Diagnosis of Barrett's Esophagus - A Pilot Study Amit Bhatt, Mansour A. Parsi, Scott L. Gabbard, Arthi Kumaravel, David Grove, Sunguk Jang, Tyler Stevens, Murthy C. Sudish, Gregory Zuccaro, John J. Vargo, Raed A. Dweik
Increased Number of Risk Factors Predicts Esophageal Injury and Metaplasia: Results From a Large Prospective Population-Based Study Nicholas R. Crews, Kelly T. Dunagan, Michele L. Johnson, Felicity Enders, Cathy D. Schleck, Louis M. Wong Kee Song, Kenneth K. Wang, David A. Katzka, Prasad G. Iyer
Background: Endoscopic surveillance of Barrett's esophagus (BE) is effective for detecting esophageal dysplasia and cancer at an early and curable stage. Unfortunately, most patients diagnosed with EAC are not identified in a BE screening program and have advanced disease. Therefore, an easy and non-invasive blood or breath test to detect BE may help get more patients into endoscopic surveillance. Breath testing is an ideal non-invasive test that detects volatile organic compounds (VOCs) that diffuse from the body into the lungs. To identify potential breath and blood makers, we compared VOCs in the headspace (gas above the sample) of whole blood from patients with BE without prior treatment and those with gastroesophageal reflux disease (GERD) and no BE. Methods: Blood samples were collected prior endoscopy. Samples were frozen (-80°C) within 30 minutes of collection until the time of analysis. The samples were heated to 40°C to allow the VOCs in the headspace to come into equilibrium with the sample. 20 milliliters of headspace was removed and analyzed to determine the concentration of 22 pre-selected VOCs that are most commonly found in breath. Results: The headspaces from 16 blood samples (6 GERD and 10 BE) were analyzed. Isoprene levels were significantly higher in the headspace of patients with BE compared to those with GERD (11.6, 8.9 (P<0.039)) (Figure 1) Isoprene identified patients with BE with an AUCROC 0.82 (95% CI: 0.59,1.00). (Figure 2) Other VOCs analyzed were not differentially expressed in BE. Conclusion: Measurement of volatile isoprene in blood may identify patients with BE non-invasively. Studies are ongoing to validate these results and determine if isoprene measurement in blood and breath can help detect BE in patients with long standing reflux.
BACKGROUND AND AIMS Screening for Barrett's esophagus (BE) has historically focused on the presence of individual risk factors, particularly chronic gastroesophageal reflux (GERD) symptoms, sex, age, and central obesity. Society guidelines recommend screening in subjects with multiple risk factors. A positive correlation between the prevalence of BE and the number of risk factors has been assumed. Risk stratification based on the increased number of existing risk factors is not well studied. This study aimed to assess whether the number of risk factors can serve as a clinical tool to predict the likelihood of esophageal injury and metaplasia. DESIGN AND METHODS Olmsted county, MN residents aged 50 or older without known BE or recent endoscopy were recruited for a randomized, populationbased study investigating the efficacy of novel endoscopic screening methods. Subjects were stratified by age, sex, and GERD symptoms. Anthropometric measurements and validated GI symptom questionnaire responses were obtained. From this comprehensive, prospective data set, the number of risk factors was assessed for each subject. Six equally-weighted factors were included: male sex, age > 75 years, GERD, ever tobacco use, family history of BE or esophageal cancer and central obesity (waist-to-hip ratio (WHR) for males >0.94 and females >0.85). GERD was defined as heartburn, acid regurgitation or antacid use more than once a week or daily PPI use. Esophageal injury was defined as presence of BE and/ or esophagitis LA criteria grade B, C, or D. The risk of esophageal injury was analyzed for three groups (0-1, 2-3, or 4-6 factors present) using logistic regression. RESULTS Of the 205 residents who underwent endoscopic assessment, 38 (18.5%) subjects were found to have esophageal injury or metaplasia (esophagitis (33 total, 29 B, 4 C, 0 D) / BE (16)). 46% were male with a mean (SD) age of 70 (10) years. 33% of subjects had GER symptoms, and 98% were of Caucasian race. The rate of esophagitis/BE in the group with 0-1 risk factors was 6.1%, while the rate in group 2-3 and group 4-6 was significantly greater at 20% and 30%, respectively (p<0.05). Male sex and central obesity were independent risk factors, while age > 75 trended to, but did not reach statistical significance. The odds of esophagitis/BE was 2.9 times more (95% CI 1.1, 13.6; p<0.05) for group 2-3 compared to group 0-1. Presence of 4-6 factors had an odds of 6.7 (95% CI 1.6, 26.6; p<0.05) compared to group 0-1. CONCLUSION Esophagitis and BE are prevalent in the population. These results confirm the additive nature of risk factors, with risk appearing to increase substantially with 2 or more risk factors and likely continuing to rise as the number of factors increase. Male sex and central obesity were independent risk factors. Table 1. Risk Factors and their Associated Risk of Esophageal injury
Figure 1:{BR}ppb = parts per billion
* p < 0.05 considered significant
S-215
AGA Abstracts