September 04, 2012
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Prediction model may help identify candidates for Barrett’s esophagus screening

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A novel risk prediction model showed promise as a tool to help clinicians determine which patients with gastroesophageal reflux symptoms should be considered for endoscopic screening for Barrett’s esophagus, according to study results.

Researchers in Australia compared data from 285 patients with incident nondysplastic Barrett’s esophagus with 313 patients who had esophageal inflammatory changes without Barrett’s esophagus. The latter group served as “inflammatory controls,” the researchers wrote.

The researchers used two phases of stepwise backward logistic regression to identify predictors of Barrett’s esophagus in men and women.

They first included all significant covariates from the univariate analyses. Then they used non-significant covariates from the univariate analyses, which allowed them to identify the effects that were detectable only after adjusting for other factors.

The researchers’ final model pooled the predictors.

Data from a Barrett’s esophagus study conducted in Washington State helped validate the model for discrimination and calibration.

The predictive factors observed included age, sex, smoking status, BMI, highest level of education and frequency of use of acid suppressant medications (area under the receiver operating characteristic [ROC] curve=0.70; 95%CI, 0.66-0.74).

A moderate discrimination was observed between the model and the external comparator data set (area under the ROC curve=0.61; 95% CI, 0.56-0.66).

Results of a Hosmer–Lemeshow test also indicated that the model was well calibrated (P=.75). Predicted probability and observed risk were highly correlated, the researchers wrote.

“The prediction model performed reasonably well and has the potential to be an effective and useful clinical tool in selecting patients with gastroesophageal reflux symptoms to refer for endoscopic screening for [Barrett’s] esophagus,” the researchers concluded.

Aaron Thrift, MD, of the Cancer Control Laboratory of the Population Health Department at the Queensland Institute of Medical Research, discussed the findings with HemOnc Today. “Predicting Barrett’s esophagus based solely on symptoms (e.g., frequency of reflux) and other characteristics and lifestyle exposures is potentially feasible, but our analyses show that we need to do more work in this area,” he said. “Getting the balance between sensitivity and specificity is the challenge, so that we are not missing too many cases. We also need to make sure that the tool has some clinical value in that it sufficiently reduces the number of unnecessary endoscopies performed for Barrett’s esophagus.”