P2406 - Barrett’s Esophagus in the United States From 2005-2016: Analysis of Office Visits From the National Ambulatory Medical Care Survey

Neil Nadpara, MD¹, Jay Patel, MD¹, Jun Song, MD¹, Henry P. Parkman, MD², Zubair Malik, MD^2
1Temple University Hospital, Philadelphia, PA; ²Temple University, Philadelphia, PA

Introduction: Barrett’s Esophagus (BE) is a premalignant condition by which metastatic columnar mucosa replaces the normal stratified squamous mucosa in the distal esophagus. Most cases occur in older Caucasian males with a long-standing history of acid reflux. Our aim was to conduct a cross-sectional study examining trends in demographics and medications use of BE patients in the US from 2005-2016.

Methods: The CDC’s National Ambulatory Medical Care Survey (NAMCS) uses weighted sampling methods to generate cross-sectional data representative of ambulatory care visits in the US. Using ICD-9 code 530.85 (BE), we identified patients with BE for the period 2005-2016. For these patients, we identified patients with GERD (ICD-9 530.81 or 530.11) and used visit codes to identify presenting symptoms and drug codes to evaluate PPI and H2 blocker use. Weighting of encounters using SPSS were performed to provide population estimates.

Results: There were 6,803,008 unique outpatient visits for BE. Mean age was 61.2 ± 14.7y, 57.9% male, and 95.6% non-Hispanic white. Mean age in males was 58.7±14.5y vs. females 64.8 ± 14.3y (p< 0.01). Median BMI was 25.8, 16.6% of patients were obese, and 14.8% had current tobacco use. Overall, 69.6% of visits were to a gastroenterologist (GI), 26.9% to a primary care provider (PCP), and 3.5% to surgery. Mean time spent per visit was 21.8± 11.2m. Among presenting complaints for the visit, 7.4% had abdominal pain, 5.6% had dysphagia, 2.8% with heartburn, and most had no GI complaints. 34.6% of patients had concomitant GERD. Most patients were on PPI therapy (69.4%): 23.4% on esomeprazole, 23.3% omeprazole, 14.1% pantoprazole, and 8.8% lansoprazole. 29.5% were no PPI or H2 blocker, 5.6% were on H2 blocker in addition to PPI, and 5.6 % were on aspirin. PPI use has significantly decreased from 86.3% in 2005-2008 to 62.7% in 2009-2012 to 62.1% in 2013-2016 (p< 0.01).

Discussion: Our nationwide results reaffirm that BE predominantly affects older, obese, Caucasian, males. Over one-third of BE patients had GERD, which is 3 times higher than the general population supporting the association. Most BE patients were asymptomatic during their office visit and were primarily seen by a GI specialist. Current guidelines recommend indefinite PPI use for patients with BE; our study showed that though most were on PPI, one-third of patients are not at their office visits when predominantly asymptomatic and PPI use has decreased over time. Continued vigilance in treating patients with BE is needed.


Disclosures:
Neil Nadpara indicated no relevant financial relationships.
Jay Patel indicated no relevant financial relationships.
Jun Song indicated no relevant financial relationships.
Henry Parkman indicated no relevant financial relationships.
Zubair Malik indicated no relevant financial relationships.


Neil Nadpara, MD¹, Jay Patel, MD¹, Jun Song, MD¹, Henry P. Parkman, MD², Zubair Malik, MD². P2406 - Barrett’s Esophagus in the United States From 2005-2016: Analysis of Office Visits From the National Ambulatory Medical Care Survey, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.