Abstract
Background
Clinical prediction models targeting patients for Barrett’s esophagus (BE) screening include data obtained by interview, questionnaire, and body measurements. A tool based on electronic health records (EHR) data could reduce cost and enhance usability, particularly if combined with non-endoscopic BE screening methods.
Aims
To determine whether EHR-based data can identify BE patients.
Methods
We performed a retrospective review of patients ages 50–75 who underwent a first-time esophagogastroduodenoscopy. Data extracted from the EHR included demographics and BE risk factors. Endoscopy and pathology reports were reviewed for histologically confirmed BE. Screening criteria modified from clinical guidelines were assessed for association with BE. Subsequently, a score based on multivariate logistic regression was developed and assessed for its ability to identify BE subjects.
Results
A total of 2931 patients were assessed, and BE was found in 1.9%. Subjects who met screening criteria were more likely to have BE (3.3% vs. 1.1%, p = 0.001), and the criteria predicted BE with an AUROC of 0.65 (95% CI 0.59–0.71). A score based on logistic regression modeling included gastroesophageal reflux disease, sex, body mass index, and ever-smoker status and identified BE subjects with an AUROC of 0.71 (95% CI 0.64–0.77). Both prediction tools produced higher AUROCs in women than in men.
Conclusions
EHR-based BE risk prediction tools identify BE patients with fair accuracy. While these tools may improve the efficiency of patient targeting for BE screening in the primary care setting, challenges remain to identify high-risk patients for non-invasive BE screening in clinical practice.
Similar content being viewed by others
References
Abrams JA, Sharaiha RZ, Gonsalves L, Lightdale CJ, Neugut AI. Dating the rise of esophageal adenocarcinoma: analysis of connecticut tumor registry data, 1940–2007. Cancer Epidemiol Biomark Prev. 2011;20:183–186. https://doi.org/10.1158/1055-9965.EPI-10-0802.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30. https://doi.org/10.3322/caac.21442.
Njei B, McCarty TR, Birk JW. Trends in esophageal cancer survival in United States adults from 1973 to 2009: a SEER database analysis. J Gastroenterol Hepatol. 2016;31:1141–1146. https://doi.org/10.1111/jgh.13289.
Cooper GS, Kou TD, Chak A. Receipt of previous diagnoses and endoscopy and outcome from esophageal adenocarcinoma: a population-based study with temporal trends. Am J Gastroenterol. 2009;104:1356–1362. https://doi.org/10.1038/ajg.2009.159.
El-Serag HB, Naik AD, Duan Z, et al. Surveillance endoscopy is associated with improved outcomes of oesophageal adenocarcinoma detected in patients with Barrett’s oesophagus. Gut. 2016;65:1252–1260. https://doi.org/10.1136/gutjnl-2014-308865.
Qiao Y, Hyder A, Bae SJ, et al. Surveillance in patients with Barrett’s esophagus for early detection of esophageal adenocarcinoma: a systematic review and meta-analysis. Clin Transl Gastroenterol. 2015;6:e131. https://doi.org/10.1038/ctg.2015.58.
Wang KK, Sampliner RE. Practice parameters Committee of the American College of G. updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol. 2008;103:788–797. https://doi.org/10.1111/j.1572-0241.2008.01835.x.
Tramontano AC, Sheehan DF, Yeh JM, et al. The impact of a prior diagnosis of Barrett’s esophagus on esophageal adenocarcinoma survival. Am J Gastroenterol. 2017;112:1256–1264. https://doi.org/10.1038/ajg.2017.82.
Verbeek RE, Leenders M, Ten Kate FJ, et al. Surveillance of Barrett’s esophagus and mortality from esophageal adenocarcinoma: a population-based cohort study. Am J Gastroenterol. 2014;109:1215–1222. https://doi.org/10.1038/ajg.2014.156.
Phoa KN, van Vilsteren FG, Weusten BL, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA. 2014;311:1209–1217. https://doi.org/10.1001/jama.2014.2511.
Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360:2277–2288. https://doi.org/10.1056/NEJMoa0808145.
American Gastroenterological A, Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ. American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology. 2011;140:1084–1091. https://doi.org/10.1053/j.gastro.2011.01.030.
Chan DK, Zakko L, Visrodia KH, et al. Breath testing for Barrett’s esophagus using exhaled volatile organic compound profiling with an electronic nose device. Gastroenterology. 2017;152:24–26. https://doi.org/10.1053/j.gastro.2016.11.001.
di Pietro M, Chan D, Fitzgerald RC, Wang KK. Screening for Barrett’s esophagus. Gastroenterology. 2015;148:912–923. https://doi.org/10.1053/j.gastro.2015.02.012.
Iyer PG, Taylor WR, Johnson ML, et al. Highly discriminant methylated DNA markers for the non-endoscopic detection of Barrett’s esophagus. Am J Gastroenterol. 2018;113:1156–1166. https://doi.org/10.1038/s41395-018-0107-7.
Shaheen NJ, Falk GW, Iyer PG, Gerson LB. American College of G. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2016;111:30–50. https://doi.org/10.1038/ajg.2015.322.
Ross-Innes CS, Debiram-Beecham I, O’Donovan M, et al. Evaluation of a minimally invasive cell sampling device coupled with assessment of trefoil factor 3 expression for diagnosing Barrett’s esophagus: a multi-center case-control study. PLoS Med. 2015;12:e1001780. https://doi.org/10.1371/journal.pmed.1001780.
Snider EJ, Compres G, Freedberg DE, et al. Barrett’s esophagus is associated with a distinct oral microbiome. Clin Transl Gastroenterol. 2018;9:135. https://doi.org/10.1038/s41424-018-0005-8.
Edelstein ZR, Bronner MP, Rosen SN, Vaughan TL. Risk factors for Barrett’s esophagus among patients with gastroesophageal reflux disease: a community clinic-based case-control study. Am J Gastroenterol. 2009;104:834–842. https://doi.org/10.1038/ajg.2009.137.
Gerson LB, Edson R, Lavori PW, Triadafilopoulos G. Use of a simple symptom questionnaire to predict Barrett’s esophagus in patients with symptoms of gastroesophageal reflux. Am J Gastroenterol. 2001;96:2005–2012. https://doi.org/10.1111/j.1572-0241.2001.03933.x.
Ireland CJ, Fielder AL, Thompson SK, Laws TA, Watson DI, Esterman A. Development of a risk prediction model for Barrett’s esophagus in an Australian population. Dis Esophagus. 2017;30:1–8. https://doi.org/10.1093/dote/dox033.
Liu X, Wong A, Kadri SR, et al. Gastro-esophageal reflux disease symptoms and demographic factors as a pre-screening tool for Barrett’s esophagus. PLoS ONE. 2014;9:e94163. https://doi.org/10.1371/journal.pone.0094163.
Locke GR, Zinsmeister AR, Talley NJ. Can symptoms predict endoscopic findings in GERD? Gastrointest Endosc. 2003;58:661–670.
Rubenstein JH, Morgenstern H, Appelman H, et al. Prediction of Barrett’s esophagus among men. Am J Gastroenterol. 2013;108:353–362. https://doi.org/10.1038/ajg.2012.446.
Thrift AP, Kendall BJ, Pandeya N, Vaughan TL, Whiteman DC, Study of Digestive H. A clinical risk prediction model for Barrett esophagus. Cancer Prev Res (Phila). 2012;5:1115–1123. https://doi.org/10.1158/1940-6207.capr-12-0010.
Eloubeidi MA, Provenzale D. Clinical and demographic predictors of Barrett’s esophagus among patients with gastroesophageal reflux disease: a multivariable analysis in veterans. J Clin Gastroenterol. 2001;33:306–309.
Ford AC, Forman D, Reynolds PD, Cooper BT, Moayyedi P. Ethnicity, gender, and socioeconomic status as risk factors for esophagitis and Barrett’s esophagus. Am J Epidemiol. 2005;162:454–460. https://doi.org/10.1093/aje/kwi218.
Corley DA, Kubo A, Zhao W. Abdominal obesity and the risk of esophageal and gastric cardia carcinomas. Cancer Epidemiol Biomark Prev. 2008;17:352–358. https://doi.org/10.1158/1055-9965.EPI-07-0748.
Abrams JA, Fields S, Lightdale CJ, Neugut AI. Racial and ethnic disparities in the prevalence of Barrett’s esophagus among patients who undergo upper endoscopy. Clin Gastroenterol Hepatol. 2008;6:30–34. https://doi.org/10.1016/j.cgh.2007.10.006.
Anderson LA, Watson RG, Murphy SJ, et al. Risk factors for Barrett’s oesophagus and oesophageal adenocarcinoma: results from the FINBAR study. World J Gastroenterol. 2007;13:1585–1594.
Corley DA, Kubo A, Levin TR, et al. Abdominal obesity and body mass index as risk factors for Barrett’s esophagus. Gastroenterology. 2007;133:34–41. https://doi.org/10.1053/j.gastro.2007.04.046.
Rubenstein JH, Mattek N, Eisen G. Age- and sex-specific yield of Barrett’s esophagus by endoscopy indication. Gastrointest Endosc. 2010;71:21–27. https://doi.org/10.1016/j.gie.2009.06.035.
Smith KJ, O’Brien SM, Green AC, Webb PM, Whiteman DC, Study of Digestive H. Current and past smoking significantly increase risk for Barrett’s esophagus. Clin Gastroenterol Hepatol. 2009;7:840–848. https://doi.org/10.1016/j.cgh.2009.04.018.
Spechler SJ, Jain SK, Tendler DA, Parker RA. Racial differences in the frequency of symptoms and complications of gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2002;16:1795–1800.
Whiteman DC, Sadeghi S, Pandeya N, et al. Combined effects of obesity, acid reflux and smoking on the risk of adenocarcinomas of the oesophagus. Gut. 2008;57:173–180. https://doi.org/10.1136/gut.2007.131375.
Le CT. A solution for the most basic optimization problem associated with an ROC curve. Stat Methods Med Res. 2006;15:571–584. https://doi.org/10.1177/0962280206070637.
Rubenstein JH, Scheiman JM, Sadeghi S, Whiteman D, Inadomi JM. Esophageal adenocarcinoma incidence in individuals with gastroesophageal reflux: synthesis and estimates from population studies. Am J Gastroenterol. 2011;106:254–260. https://doi.org/10.1038/ajg.2010.470.
Thrift AP, Kendall BJ, Pandeya N, Whiteman DC. A model to determine absolute risk for esophageal adenocarcinoma. Clin Gastroenterol Hepatol. 2013;11:138–144e2. https://doi.org/10.1016/j.cgh.2012.10.026.
Xie SH, Lagergren J. A model for predicting individuals’ absolute risk of esophageal adenocarcinoma: moving toward tailored screening and prevention. Int J Cancer. 2016;138:2813–2819. https://doi.org/10.1002/ijc.29988.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Julian Abrams has consulted for Medtronic.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Baldwin-Hunter, B.L., Knotts, R.M., Leeds, S.D. et al. Use of the Electronic Health Record to Target Patients for Non-endoscopic Barrett’s Esophagus Screening. Dig Dis Sci 64, 3463–3470 (2019). https://doi.org/10.1007/s10620-019-05707-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-019-05707-2