Digestive Diseases and Sciences

, Volume 54, Issue 5, pp 964–971 | Cite as

Prevalence of Complicated Gastroesophageal Reflux Disease and Barrett’s Esophagus Among Racial Groups in a Multi-Center Consortium

  • Amy Wang
  • Nora C. Mattek
  • Jennifer L. Holub
  • David A. Lieberman
  • Glenn M. Eisen
Original Article

Abstract

Aims The Clinical Outcomes Research Initiative database was used to evaluate ethnic trends in complicated reflux disease and suspected Barrett’s esophagus among various racial groups. Methods Endoscopic findings for procedures performed January 2000–December 2005 for any indication and for reflux-related indications were reviewed by racial group. Results Of 280,075 procedures examined, Hispanics were the most likely to have esophagitis (Hispanic 19.6%, white 17.3%, black 15.8%, Asian/Pacific Islander 9.5%, P-value < 0.0001), and white subjects were most likely to have suspected BE (white 5.0%, Hispanic 2.9%, Asian/Pacific Islander 1.8%, black 1.5%, P-value < 0.0001). Endoscopies performed for reflux-related indications had similar trends for esophagitis and esophageal stricture. Among reflux/Barrett’s screening procedures adjusted for age and gender, Hispanics were most likely to have esophagitis (OR = 1.28, P-value < 0.0001) compared to Caucasians. Conclusion Our results demonstrate an association of suspected Barrett’s esophagus and stricture with white patients and esophagitis with Hispanic patients. These findings need to be followed-up with further study.

Keywords

Barrett’s esophagus Esophagitis Stricture Minority groups Race 

Abbreviations

API

Asian/Pacific Islander

ACG

American College of Gastroenterology

BE

Barrett’s esophagus

BNH

Black non-Hispanic

CMS

Centers for Medicare and Medicaid Service

CORI

Clinical Outcomes Research Initiative

GERD

Gastroesophageal reflux disease

LA

Los Angeles

LSBE

Long-segment Barrett’s esophagus

NED

National Endoscopic Database

NNE

Number needed to endoscope

PPI

Proton pump inhibitors

SSBE

Short-segment Barrett’s esophagus

VA

Veteran’s Affairs

WNH

White non-Hispanic

Notes

Acknowledgments

This project was supported with funding from NIDDK UO1 CA 89389-01 and R33-DK61778-01. In addition, the practice network (CORI) has received support from the following entities to support the infrastructure of the practice-based network: AstraZeneca, Bard International, Pentax USA, ProVation, Endosoft, GIVEN Imaging, and Ethicon. The commercial entities had no involvement in this research. DL is the executive director of CORI and GE is the executive co-director of CORI, a nonprofit organization that receives funding from federal and industry sources. This potential conflict of interest has been reviewed and managed by the Oregon Health and Science University (OHSU) Conflict of Interest in Research Committee. This research was conducted with support from the Investigator-Sponsored Study Program of AstraZeneca.

References

  1. 1.
    Locke GR III, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ III. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology. 1997;112:1448–1456. doi:10.1016/S0016-5085(97)70025-8.PubMedCrossRefGoogle Scholar
  2. 2.
    Locke GR III, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ III. Risk factors associated with symptoms of gastroesophageal reflux. Am J Med. 1999;106:642–649. doi:10.1016/S0002-9343(99)00121-7.PubMedCrossRefGoogle Scholar
  3. 3.
    Talley NJ, Zinsmeister AR, Schleck CD, Melton LJ III. Dyspepsia and dyspepsia subgroups: a population-based study. Gastroenterology. 1992;102:1259–1268.PubMedGoogle Scholar
  4. 4.
    DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005;100:190–200. doi:10.1111/j.1572-0241.2005.41217.x.PubMedCrossRefGoogle Scholar
  5. 5.
    Nandurkar S, Locke GR III, Murray JA, et al. Rates of endoscopy and endoscopic findings among people with frequent symptoms of gastroesophageal reflux in the community. Am J Gastroenterol. 2005;100:1459–1465. doi:10.1111/j.1572-0241.2005.41115.x.PubMedCrossRefGoogle Scholar
  6. 6.
    Sampliner RE. Updated guidelines for the diagnosis, surveillance, and therapy of Barrett’s esophagus. Am J Gastroenterol. 2002;97:1888–1895. doi:10.1111/j.1572-0241.2002.05910.x.PubMedCrossRefGoogle Scholar
  7. 7.
    Wang KK, Sampliner RE. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol. 2008;103:788–797. doi:10.1111/j.1572-0241.2008.01835.x.PubMedCrossRefGoogle Scholar
  8. 8.
    Wong WM, Lam SK, Hui WM, et al. Long-term prospective follow-up of endoscopic oesophagitis in southern Chinese—Prevalence and spectrum of the disease. Aliment Pharmacol Ther. 2002;16:2037–2042. doi:10.1046/j.1365-2036.2002.01373.x.PubMedCrossRefGoogle Scholar
  9. 9.
    Spechler SJ, Goyal RK. Barrett’s esophagus. N Engl J Med. 1986;315:362–371.PubMedGoogle Scholar
  10. 10.
    Lee JI, Park H, Jung HY, Rhee PL, Song CW, Choi MG. Prevalence of Barrett’s esophagus in an urban Norean population: a multicenter study. J Gastroenterol. 2003;38:23–27. doi:10.1007/s005350300002.PubMedCrossRefGoogle Scholar
  11. 11.
    Sonnenberg A, Massey BT, Jacobsen SJ. Hospital discharges resulting from esophagitis among Medicare beneficiaries. Dig Dis Sci. 1994;39:183–188. doi:10.1007/BF02090080.PubMedCrossRefGoogle Scholar
  12. 12.
    El-Serag HB, Petersen NJ, Carter J, et al. Gastroesophageal reflux among different racial groups in the United States. Gastroenterology. 2004;126:1692–1699. doi:10.1053/j.gastro.2004.03.077.PubMedCrossRefGoogle Scholar
  13. 13.
    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. doi:10.1093/aje/kwi218.PubMedCrossRefGoogle Scholar
  14. 14.
    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. doi:10.1046/j.1365-2036.2002.01351.x.PubMedCrossRefGoogle Scholar
  15. 15.
    Bersentes K, Fass R, Padda S, Johnson C, Sampliner RE. Prevalence of Barrett’s esophagus in Hispanics is similar to Caucasians. Dig Dis Sci. 1998;43:1038–1041. doi:10.1023/A:1018834902694.PubMedCrossRefGoogle Scholar
  16. 16.
    Rajendra S, Kutty K, Karim N. Ethnic differences in the prevalence of endoscopic esophagitis and Barrett’s esophagus: the long and short of it all. Dig Dis Sci. 2004;49:237–242. doi:10.1023/B:DDAS.0000017444.30792.94.PubMedCrossRefGoogle Scholar
  17. 17.
    Yeh C, Hsu CT, Ho AS, Sampliner RE, Fass R. Erosive esophagitis and Barrett’s esophagus in Taiwan: a higher frequency than expected. Dig Dis Sci. 1997;42:702–706. doi:10.1023/A:1018835324210.PubMedCrossRefGoogle Scholar
  18. 18.
    Sonnenberg A, Amorosi SL, Lacey MJ, Lieberman DA. Patterns of endoscopy in the United States: analysis of data from the centers for Medicare and Medicaid services and the National Endoscopic Database. Gastrointest Endosc. 2008;67:489–496.PubMedGoogle Scholar
  19. 19.
    Ruhl CE, Everhart JE. Overweight, but not high dietary fat intake, increases risk of gastroesophageal reflux disease hospitalization: the NHANES I Epidemiologic Follow-up Study. First national health and nutrition examination survey. Ann Epidemiol. 1999;9:424–435. doi:10.1016/S1047-2797(99)00020-4.PubMedCrossRefGoogle Scholar
  20. 20.
    Nilsson M, Johnsen R, Ye W, Hveem K, Lagergren J. Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. JAMA. 2003;290:66–72. doi:10.1001/jama.290.1.66.PubMedCrossRefGoogle Scholar
  21. 21.
    El-Serag HB, Graham DY, Satia JA, Rabeneck L. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol. 2005;100:1243–1250. doi:10.1111/j.1572-0241.2005.41703.x.PubMedCrossRefGoogle Scholar
  22. 22.
    Nocon M, Labenz J, Willich SN. Lifestyle factors and symptoms of gastro-oesophageal reflux—a population-based study. Aliment Pharmacol Ther. 2006;23:169–174. doi:10.1111/j.1365-2036.2006.02727.x.PubMedCrossRefGoogle Scholar
  23. 23.
    Veugelers PJ, Porter GA, Guernsey DL, Casson AG. Obesity and lifestyle risk factors for gastroesophageal reflux disease, Barrett esophagus and esophageal adenocarcinoma. Dis Esophagus. 2006;19:321–328. doi:10.1111/j.1442-2050.2006.00602.x.PubMedCrossRefGoogle Scholar
  24. 24.
    Mohammed I, Nightingale P, Trudgill NJ. Risk factors for gastro-oesophageal reflux disease symptoms: a community study. Aliment Pharmacol Ther. 2005;21:821–827. doi:10.1111/j.1365-2036.2005.02426.x.PubMedCrossRefGoogle Scholar
  25. 25.
    Graham DY, Yamaoka Y. H. pylori and cagA: relationships with gastric cancer, duodenal ulcer, and reflux esophagitis and its complications. Helicobacter. 1998;3:145–151. doi:10.1046/j.1523-5378.1998.08031.x.PubMedCrossRefGoogle Scholar
  26. 26.
    Loffeld RJ, Werdmuller BF, Kuster JG, Perez-Perez GI, Blaser MJ, Kuipers EJ. Colonization with cagA-positive Helicobacter pylori strains inversely associated with reflux esophagitis and Barrett’s esophagus. Digestion. 2000;62:95–99. doi:10.1159/000007801.PubMedCrossRefGoogle Scholar
  27. 27.
    Varanasi RV, Fantry GT, Wilson KT. Decreased prevalence of Helicobacter pylori infection in gastroesophageal reflux disease. Helicobacter. 1998;3:188–194. doi:10.1046/j.1523-5378.1998.08001.x.PubMedCrossRefGoogle Scholar
  28. 28.
    Banthin JS, Miller GE. Trends in prescription drug expenditures by Medicaid enrollees. Med Care. 2006;44:I27–I35. doi:10.1097/01.mlr.0000208132.36055.84.PubMedCrossRefGoogle Scholar
  29. 29.
    Cloud ML, Enas N, Humphries TJ, Bassion S. Rabeprazole in treatment of acid peptic diseases: results of three placebo-controlled dose-response clinical trials in duodenal ulcer, gastric ulcer, and gastroesophageal reflux disease (GERD). The Rabeprazole Study Group. Dig Dis Sci. 1998;43:993–1000. doi:10.1023/A:1018822532736.PubMedCrossRefGoogle Scholar
  30. 30.
    Earnest DL, Dorsch E, Jones J, Jennings DE, Greski-Rose PA. A placebo-controlled dose-ranging study of lansoprazole in the management of reflux esophagitis. Am J Gastroenterol. 1998;93:238–243. doi:10.1111/j.1572-0241.1998.00238.x.PubMedCrossRefGoogle Scholar
  31. 31.
    Hetzel DJ, Dent J, Reed WD, et al. Healing and relapse of severe peptic esophagitis after treatment with omeprazole. Gastroenterology. 1988;95:903–912.PubMedGoogle Scholar
  32. 32.
    Richter JE, Bochenek W. Oral pantoprazole for erosive esophagitis: a placebo-controlled, randomized clinical trial. Pantoprazole US GERD Study Group. Am J Gastroenterol. 2000;95:3071–3080. doi:10.1111/j.1572-0241.2000.03254.x.PubMedCrossRefGoogle Scholar
  33. 33.
    Sontag SJ, Hirschowitz BI, Holt S, et al. Two doses of omeprazole versus placebo in symptomatic erosive esophagitis: the U.S. Multicenter Study. Gastroenterology. 1992;102:109–118.PubMedGoogle Scholar
  34. 34.
    Wong WM, Lai KC, Lam KF, et al. Prevalence, clinical spectrum and health care utilization of gastro-oesophageal reflux disease in a Chinese population: a population-based study. Aliment Pharmacol Ther. 2003;18:595–604. doi:10.1046/j.1365-2036.2003.01737.x.PubMedCrossRefGoogle Scholar
  35. 35.
    Bliss EB, Meyers DS, Phillips RL Jr, Fryer GE, Dovey SM, Green LA. Variation in participation in health care settings associated with race and ethnicity. J Gen Intern Med. 2004;19:931–936. doi:10.1007/s11606-004-0008-x.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Amy Wang
    • 1
  • Nora C. Mattek
    • 1
  • Jennifer L. Holub
    • 1
  • David A. Lieberman
    • 1
  • Glenn M. Eisen
    • 1
  1. 1.Department of GastroenterologyOregon Health and Science UniversityPortlandUSA

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