P0319 - Patient Factors Associated With Gastroesophageal Reflux Disease Diagnostic Evaluation Strategies: A Retrospective Cohort Study

Ravy K. Vajravelu, MD, MSCE¹, Jennifer Kolb, MD, MS², Frank I. Scott, MD, MSCE³, Anna Tavakkoli, MD, MSc⁴, Amit G. Singal, MD, MS⁵, David A. Katzka, MD⁶, Gary Falk, MD, MS, FACG⁷, Sachin Wani, MD^3
1University of Pittsburgh School of Medicine, Pittsburgh, PA; ²University of California Irvine, Orange, CA; ³University of Colorado Anschutz Medical Campus, Aurora, CO; ⁴University of Texas Southwestern Medical Center at Dallas, Dallas, TX; ⁵University of Texas Southwestern Medical Center, Dallas, TX; ⁶Mayo Clinic, Rochester, MN; ⁷University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

Introduction: Barrett’s esophagus (BE) screening is not highly utilized in the United States. The development of BE risk stratification algorithms and minimally-invasive testing modalities may improve adoption of BE screening in the future. To guide the implementation of these tools, we aimed to describe practice patterns for diagnostic evaluation of gastroesophageal reflux disease (GERD) of non-gastroenterologists in the United States.

Methods: We performed a retrospective cohort study using Optum, a database of large commercial and Medicare Advantage health plans from 2004 – 2019. We identified individuals newly diagnosed with GERD by a non-gastroenterology provider. Among these patients, we determined patient factors associated with completion of a subsequent gastroenterology encounter by fitting Cox models. Of patients who completed a gastroenterology encounter, we identified patient factors associated with whether the first gastroenterology encounter was a direct-access upper endoscopy or an office visit using logistic regression. Sensitivity analyses limiting the analysis to patients with GERD for ≥1 year were performed. The Institutional Review Board of our institution classified this research as exempt.

Results: We identified 1,549,553 patients newly diagnosed with GERD. Seventy-two percent of these were initially diagnosed by a primary care provider (patient characteristics in Table). The cumulative incidence of completing a gastroenterology encounter within five years was 29.9%. Of patients who completed a gastroenterology encounter, 49.7% underwent direct-access upper endoscopy (associated patient factors associated in Figure). Strongly associated patient factors included dysphagia (aOR 1.79, 95% CI 1.67 – 1.91), weight loss (aOR 1.56, 95% CI 1.45 – 1.67), and melena/rectal bleeding (aOR 1.42, 95% CI 1.33 – 1.52).

Discussion: In this retrospective cohort study of more than 1.5 million patients with newly diagnosed GERD, we found that 72% of patients were initially diagnosed by primary care providers. This result underscores the importance of targeting primary care providers for BE screening initiatives as the cumulative incidence of completing a gastroenterology encounter within five years was only 30%. Furthermore, non-specific gastrointestinal symptoms were more strongly associated with direct-access upper endoscopy than established BE risk factors. These results may provide insights for the implementation of future BE screening strategies.




Disclosures:


Ravy K. Vajravelu, MD, MSCE¹, Jennifer Kolb, MD, MS², Frank I. Scott, MD, MSCE³, Anna Tavakkoli, MD, MSc⁴, Amit G. Singal, MD, MS⁵, David A. Katzka, MD⁶, Gary Falk, MD, MS, FACG⁷, Sachin Wani, MD³. P0319 - Patient Factors Associated With Gastroesophageal Reflux Disease Diagnostic Evaluation Strategies: A Retrospective Cohort Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.