Clinical Studies
Studies (2009):
- Prevalence of Barrett's Esophagus in Austria - Study:
Background: In addition to symptom induced impairment of the life quality (1), GERD is associated with a premalignant morphologic complication: columnar lined esophagus (CLE) with intestinal metaplasia (=Barrett's esophagus) (2). Those with Barrett's esophagus are at 0.5% annual risk to develop esophageal cancer (adenocarcinoma of the esophagus): 1 out of 10 persons with Barrett's can develop cancer in 20 years (3). Since we do not know who is going to proceed towards cancer (along a sequence via low- and high grade dysplasia) surveillance endoscopies are offered to those with Barrett's esophagus (4). In Austria, the incidence of GERD induced adenocarcinoma of the esophagus increased 3.5 fold since 15 years (currently 300 new cases per year) (5).
Size of the problem: The prevalence of Barrett's esophagus for the Austrian population is not known. Endoscopy and biopsy studies coming from the Surgical Department of the Medical University Vienna (MUW) including more than 300 individuals show presence of Barrett's in 25% -30% of those with GERD symptoms (GERD+) (6,7). Prevalence of Barrett's in persons without GERD symptoms (GERD-, never ever use of PPIs) was 15%. These data justify to assess the "ideal" age for screening endoscopy of the esophagus in women and men (gender specific). So far no country in the world has been launching such a nation wide Barrett's prevalence study.
Aim of the study: The Barrett's Prevalence study is initiated and organized by the "GERD Center of Excellence" and aims to assess the gender specific prevalence of Barrett's esophagus in the normal Austrian population.
Methods: An unselected sample of 2000 persons (random inclusion via the national health insurance registry) will be invited to undergo upper GI endoscopy. Endoscopies will be conducted using the video endoscopy equipment by Olympus, Austria (including narrow band imaging technology for improved detection of mucosal irregularities). During the endoscopy 4 quadrant biopsies will be obtained from the level of the rise of the endoscopic gastric type folds (=level zero biopsies) (6-9). Measured biopsies will be obtained at 0.5 cm increments from segments and/or tongues of endoscopic visible columnar lined esophagus (CLEv). Biopsies from each level are separately processed for histopathology. Histopathology is conducted according to the Paull-Chandrasoma classification (2-4).
Participating Endoscopy Centers & Phycisians:
Prof. Rainer Schöfl, Elisabethinen, Linz
Prof. Dr. Peter Michael Heinermann, PMU, LKH Salzburg
Prof. Dr. Thomas Hinterleitner, Univ. Clinic of Gastroenterology, Graz
Prof. Dr. Heinz Wykypiel, Univ. Clinic of Surgery, Innsbruck
Prof. Dr. Etienne Wenzl, Department of Surgery, LKH Feldkrich
Dr. Michael Häfner, Univ. Clinic of Gastroenterology, Vienna
Prof. Dr. Johannes Zacherl, Univ. Clinic of Surgery, Vienna
Prof. Dr. Gerhard Prager, Univ. Clinic of Surgery, Vienna
Prof. Dr. Sebastian Schoppmann, Univ. Clinic of Surgery, Vienna
Prof. Dr. Martin Riegler, Univ. Clinic of Surgery, Vienna
Results: Primary outcome measure: gender and age specific prevalence of Barrett's esophagus defined as the presence of intestinal metaplasia within cardiac mucosa. Secondary outcome measures: symptom & life style associations.
Conclusion: Assess the "ideal" gender specific age for screening endoscopy of the esophagus.
Outlook: Cancer prevention (=decrease the incidence of cancer) by increase of screening endoscopies and early treatment of Barrett's esophagus (i.e. radiofrequency ablation, endoscopic resection, fundoplication). In the long run this is suggested to lower the costs (endoscopy + biopsies versus esophageal resection and chemotherapy).
- Assoziation between paradontosis and GERD:
Interdisciplinary study (maxillofacial surgery, general surgery & manometry lab at Vienna Medical University; MUW); correlation between presence of paradontosis and GERD (symptoms, histopathology, esophageal function tests).
Outlook: may paradontosis serve as an indicator for GERD and Barrett's esophagus?