Title

Prevalence of Barrett's Esophageal Mucosa in Developmentally Delayed Adults Presenting With Covert Dysphagia

Document Type

Article

Publication Date

12-1-1998

Description

Introduction: Developmentally delayed patients may not verbalize classic symptoms of gastroesophageal reflex disease and difficulty swallowing (covert dysphagia). Behavioral changes, rumination and vomiting may indicate esophageal disease. Aim: To study prevalence of reflux esophagitis and Barrett's epithelium in developmentally delayed patients without classic symptoms of reflux. Method: We prospectively studies 117 institutionalized patients with upper endoscopy for evaluation of covert symptoms between July 1995 and September 1997. All endoscopies were performed by two attending physicians. Data collected include details of endoscopy findings and results of biopsies from esophagus and antrum. All patients had previously failed stepwise empiric therapy with high dose H2 blockers, prokinetic agents or proton pump inhibitors (Omeprazole 20mg daily). Results: In the study group there were 75 males and 42 females and the ages ranged from 14 yrs to 79 yrs (mean = 45.9 yrs). Of the 117 patients, 65 (55.5%) had reflux esophagitis (95% confidence interval = 47.8% to 63.3%) as documented by endoscopy or pathology examination of biopsies from distal esophagus, while 20 (17.1%) had documented Barrett's (specialized columnar) epithelium (95% confidence interval = 10.1% to 24.1%) including 8 with long segment and 12 with short segment type Barrett's epithelium. In the esophagitis group 20 of 65 (30.8%) had Barrett's epithelium (95% confidence interval = 19.3% to 42.4%). Binary logistic regression showed that reflux esophagitis was not statistically related to age (P=0.24) or gender (P=0.37). Helicobacter pylori status was available for 68 patients, however, this was not related to reflux esophagitis (P=0.79). After subgrouping the esophagitis patients into 20 with Barrett's epithelium and 45 with non-Barrett's epithelium, ordinal logistic regression showed that age, gender and Helicobacter pylori status were not significantly related to the esophageal categories. Conclusion: There is high prevalence of reflux esophagitis and Barrett's metaplasia in developmentally delayed individuals presenting with covert symptoms. Empiric medical therapy failed to identify these subjects. Threshold for diagnostic endoscopy should be lower in these patients to better defined more aggressive medical or surgical therapy.

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