Demographics and Findings of Upper Endoscopy Patients

Barrett's esophagus is a pre-malignant condition associated with adenocarcinoma of the lower
esophagus, and is found in 10-15% of patients with Gastroesophageal Reflux Disease (GERD).
In prospective studies of patients undergoing endoscopy for reflux symptoms, the prevalence
of long segments of Barrett's Esophagus (3cm or greater) is reported to be 3% and that of
short segment Barrett's Esophagus (less than 3cm), to be approximately 7-8%. Early diagnosis
with surveillance is considered the optimal approach in patients with Barrett's, given the
poor survival of advanced adenocarcinoma of the esophagus. However, classic symptoms of GERD
may be diminished in some patients with Barrett's esophagus, possibly leading to a lower
incidence of endoscopy with early diagnosis.

Extraesophageal manifestations of GERD include hoarseness, wheezing, and globus sensation.
Dyspepsia is defined as pain or discomfort centered in the upper abdomen. Some reports have
quantified the incidence of dyspepsia as occurring in up to 40% of adults over a six-month
period. The differential diagnosis of dyspepsia includes gastric or duodenal ulcer,
gastroesophageal reflux disease, gastric cancer, and non-ulcer dyspepsia. The incidence of
peptic ulcer disease appears to be decreasing in our population, largely due to the lower
prevalence of Helicobacter pylori infection among the population. Thus, esophageal lesions
are responsible for an increasing number of dyspeptic patients.

Controversies exist as to the proper management of patients presenting with dyspepsia.
Empiric acid-suppression therapy is often the first step in the management of dyspeptic
patients. Many physicians have adopted a test-and-treat strategy for Helicobacter pylori
infection. Finally, upper endoscopy may be performed. This test is considered the gold
standard for the diagnosis of esophageal and gastroduodenal lesions. The initial evaluation
of dyspeptic patients may be modified by other factors in their presentation, i.e. age
greater than 50 or the presence of alarm symptoms (weight loss, dysphagia, evidence of
gastrointestinal bleeding, anemia, or previous gastric surgery).

A distinction between the various causes of dyspepsia is important to establish in view of
the significant differences in treatment strategies. Several previously reported studies
have established a correlation between dyspepsia, with or without peptic ulcer disease, and
erosive esophagitis. These studies were limited by a high degree of patient selection and
narrow patient populations. Although the prevalence of erosive esophagitis and Barrett's
Esophagus has been reported in patients with typical GERD symptoms, i.e. heartburn and
regurgitation, the exact prevalence in patients with atypical symptoms of GERD (cough,
asthma, wheezing, dysphagia), abdominal pain and dyspepsia is not readily known, especially
in a VA population. Given that these esophageal diseases affect mainly older Caucasian
males, studying the prevalence of these diseases in a VA population would be of extreme
significance and importance.

Inclusion Criteria:

- Patients who present to the KCVA GI endoscopy unit with symptoms of reflux,upper
abdominal pain, anemia (patients referred by their primary care physicians with a
diagnosis of low hemoglobin (< 10 G/DL, and or dyspepsia

Exclusion Criteria:

- Weight loss (Weight loss of > 10% of their mean body weight over last 6 months)

- Dysphagia

- Gastrointestinal bleeding

- Gastrointestinal malignancy

- Recent EGD (in the past 5 years)