Use of a simple symptom questionnaire to predict Barrett's esophagus in patients with symptoms of gastroesophageal reflux

OBJECTIVE: Accurately predicting Barrett's esophagus (BE) in patients with gastroesophageal reflux disease (GERD) is difficult. Using logistic regress ion analysis of symptom questionnaire scores we created a model to predict the presence of BE. METHODS: We conducted a logistic regression analysis of symptom data collec ted prospectively on 517 GERD patients and created a prediction model based on patient gender, age, ethnicity, and symptom severity. RESULTS: There were 337 (65%) males and 180 (35%) females, of whom 99 (19%) had Barrett's esophagus (BE). Multiple logistic regression analysis was pe rformed to determine the predictive ability of gender, age, and ethnicity a long with symptoms of heartburn, nocturnal pain, odynophagia, presence of b elching, dysphagia, relief of symptoms with food, and nausea. The only sign ificant predictors (at the 0.05 level) were male gender, heartburn, nocturn al pain, and odynophagia (all with positive effects on the presence of BE) and dysphagia (which had a negative effect). A nomogram was produced to sho w the effect of a given predictor on the probability of having BE in the co ntext of the effects of the other predictors, and to estimate the probabili ty of having BE for a given individual. The mean score (+/- SD) for the BE patients in our sample was 397.4 +/- 46.2 with a range of 292-530. For the patients without BE, the mean score (+/- SD) was 351.3 +/- 60.3 with a rang e of 190 - 528 (p < 0.001). If screening for BE is performed at a score of 375 or more, our model would have a specificity of 63% with a sensitivity o f 77% (95% CI 61-86% given the 63% specificity). CONCLUSIONS: By asking seven questions about symptom severity, clinicians m ay be able to assign a probability to the presence of BE, and thus, determi ne the need for endoscopy in GERD patients.