CHICAGO — There is a significant gap between expert opinion regarding Barrett's esophagus treatment and the opinions of gastroenterologists in general practice, indicating a need for ongoing physician education, Colin Howden, M.D., said at the annual Digestive Disease Week.
To test how much recent research has filtered into the general practice community, Dr. Howden and his team queried 275 gastroenterologists attending three regional conferences in 2004. The surveyed physicians were attending conferences sponsored by TAP Pharmaceutical Products Inc., but the company provided no financial support for the study and had no role in the analysis or reporting of results.
The gastroenterologists used hand-held response devices to indicate how much they agreed or disagreed with statements about the treatment of Barrett's esophagus. Their answers were compared with opinions gleaned by the American Gastroenterological Association from a panel of 18 experts in the field.
There was a high level of agreement about the definition of Barrett's esophagus and the need for multiple systematic biopsies. However, the two groups differed in their approaches to surveillance and treatment.
None of the expert panel members accepted short-segment and long-segment Barrett's esophagus as distinct clinical entities, but 41% of the gastroenterologists surveyed did. None of the expert panel members accepted that screening reduced mortality or was cost effective, but 25% of the gastroenterologists though it reduced mortality, and 13% thought it was cost effective. Also, none of the expert panel members accepted that surveillance was cost effective, but 69% of the gastroenterologists believed that it was.
“There is not complete agreement about managing Barrett's esophagus, even among the experts,” said Dr. Howden of Northwestern University, Chicago. “General gastroenterologists do a pretty good job at managing the condition, but their knowledge and understanding is a few years behind those of the experts.”
In a related presentation, Hashem El-Serag, M.D., of Baylor College of Medicine, Houston, reported on research about the incidence of Barrett's esophagus in children and adolescents.
In a group of 8,038 patients under age 18 years who had an upper endoscopy between 1999 and 2002 in the United States, only 37 had suspected Barrett's, indicating that the incidence in children is extremely low.
Community hospitals were more likely to report suspected Barrett's in children and adolescents than were pediatric hospitals. The difference was not statistically significant, but the data may indicate that the condition is so rare in children that pediatric gastroenterologists don't see it enough to recognize it, Dr. El-Serag said.