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Update in Gastroenterology and Hepatology
- Norton J. Greenberger, MD; and
- Prateek Sharma, MD
- From Harvard Medical School, Cambridge, Massachusetts, and University of Kansas School of Medicine, Kansas City, Kansas.
2006 Series: Update Sessions from ACP's 2006 Annual Session
This year's Update in Gastroenterology and Hepatology reviews a range of important findings, including new data on the prevalence of Barrett esophagus, use of clopidogrel in patients with previous bleeding from aspirin, the accuracy of fecal occult blood testing (FOBT) in screening for colorectal cancer, and the benefits and risks of using aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) for colorectal cancer prevention. A nonabsorbable antibiotic, rifaximin, was reported to be effective for prophylaxis against travelers' diarrhea. Population data shed new light on risk factors for outbreaks of Clostridiumdifficile–associated diarrhea, the natural history of nonalcoholic fatty liver disease (NAFLD), and the role of smoking in chronic pancreatitis. In addition, a meta-analysis suggested that surgery is a safe and effective treatment for obesity. Changes to clinical practice emerging from these articles are shown in the Table .
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Esophagus
Prevalence of Barrett Esophagus Is Similar in Those with and without Reflux Symptoms
Barrett esophagus is a known risk factor for esophageal adenocarcinoma, the incidence of which is rising rapidly in developing countries. Barrett esophagus is found in 10% of patients with gastroesophageal reflux disease who undergo upper endoscopy, but prevalence of Barrett esophagus in the general population is not known.
In this trial, the authors randomly sampled 3000 of 21 610 people living in 2 areas of Sweden, asking each to complete a validated questionnaire assessing gastrointestinal symptoms. A random subsample of 1000 participants (mean age, 53.5 years; 51% women) underwent upper endoscopy. Barrett esophagus was diagnosed in this subsample when biopsies of columnar-lined esophagus, characterized visually by salmon-pink mucosa in the squamocolumnar junction shifted upward circumferentially or in adjacent mucosal tongues or islands, demonstrated intestinal metaplasia.
Of the 3000 participants, 2860 responded to the invitation to complete the survey, and 2122 (74%) actually completed it. Forty percent reported reflux symptoms. Of the 1000 who had endoscopy, …
