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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.
2004–2005 Series: Update Sessions from ACP's 2004 Annual Session
This year's Update in Gastroenterology and Hepatology incorporates articles on screening and surveillance for Barrett esophagus, antimicrobial resistance in Helicobacter pylori, recurrent ulcer bleeding treatment, celiac disease diagnosis, optimal inflammatory bowel disease treatment, cyclosporine use for ulcerative colitis, the role of nonsteroidal agents in ulcerative ileitis, the effect of probiotics on antibiotic-associated diarrhea, the use of aspirin to prevent colorectal adenomas, chronic liver disease diagnosis, and the causes of acute liver failure.
Esophagus, Stomach, and Small Bowel
Cost-Effective Screening and Surveillance for Barrett Esophagus Are Limited to Patients with Dysplasia
Although one-time screening endoscopy for Barrett esophagus is recommended for patients with gastroesophageal reflux disease (GERD), little evidence exists about the cost-effectiveness of this practice. With as much as 10% of the population estimated to have GERD, many people need screening. Moreover, once a person has Barrett esophagus, the risk for cancer is only about 0.5% per year. Among patients given a diagnosis of Barrett esophagus, current guidelines recommend periodic endoscopic surveillance to detect early cancer and dysplasia.
Inadomi and colleagues wanted to determine the cost-effectiveness of screening 50-year-old white men with GERD—the subgroup at highest risk for developing esophageal adenocarcinoma—and to offer further surveillance if Barrett esophagus is diagnosed. They developed a decision analytic model to examine 3 policies: no screening or surveillance, screening and surveillance only for patients with Barrett esophagus and dysplasia, and extending surveillance to patients with Barrett esophagus and no dysplasia.
The investigators found that screening for Barrett esophagus followed by surveillance limited to patients with Barrett esophagus and dysplasia was cost-effective, requiring $10 440 per quality-adjusted life-year (QALY) saved compared with no screening or surveillance. Screening followed by surveillance for all patients with Barrett esophagus every 5 years, however, cost much more—$596 000 per QALY saved—than surveillance only for patients with Barrett esophagus and dysplasia. For surveillance of patients with Barrett esophagus and no …
