Screening for Barrett's in Otolaryngology Patients

描述(由申请人提供)： 本申请提出了一项培训计划，旨在将布莱尔·A·乔贝医学博士培养成专门研究巴雷特食道和食道癌的独立临床医生和科学家。Jobe博士是一名委员会认证的普通外科医生，接受过腹腔镜和食道外科的专科培训。指导职业发展计划包括三个层次的方法：获得临床调查硕士学位的教学教育，基础广泛的体验式学习计划，以及指导临床研究经验。该计划的主要目标将是让乔布博士在所有方面实现作为临床研究员的独立。Jobe博士目前在俄勒冈健康与科学大学(OHSU)攻读人类调查项目。这是一项由美国国立卫生研究院(NIH)赞助的为期两年的项目，旨在培养以患者为中心的研究技能。指导研究将在指导委员会的指导下进行，指导委员会由OHSU医学信息学和结果研究教授Cynthia Morris博士、OHSU胃肠病学部主任David Lieberman博士和OHSU外科主任John Hunter博士组成。南加州大学的杰弗里·彼得斯博士将担任非现场导师和委员会成员。这项拟议的研究侧重于改善食管腺癌的风险分层。事实上，大多数患者在癌症诊断之前并不知道Barrett‘s食道的存在，而且因为这些患者中的很大一部分从来没有出现烧心或反流，这表明目前基于GERD症状的筛查范例可能是不够的。我们推测，有食道外反流症状的患者有未被识别的食道损伤的风险，因此Barrett‘s食道。我们假设，与没有胃食道反流症状的患者相比，有食道外反流症状的患者的内窥镜筛查将显示Barrett‘s食道的患病率显著更高。主要目的是确定转诊到耳鼻喉科诊所的有食道外反流症状的患者的巴雷特化生的患病率与有GERD症状的人群的患病率相当。第二个目标是确定办公室内未使用镇静剂的小口径内窥镜检查是准确的，当用于Barrett‘s食道筛查程序时，患者可以接受。

DESCRIPTION (provided by applicant): This application proposes a training program to develop Blair A. Jobe, MD into an independent clinician-scientist specializing in investigations of Barrett's esophagus and esophageal cancer. Dr. Jobe is a board certified General Surgeon with subspecialty training in laparoscopic and esophageal surgery. The mentored career development plan consists of a three-tiered approach: a didactic education resulting in a Masters in Clinical Investigation degree, a broad-based experiential learning program, and a mentored clinical research experience. The primary goal of this program will be for Dr. Jobe to achieve independence as a clinical investigator in all respects. Dr. Jobe is currently enrolled in the Human Investigations Program at Oregon Health and Science University (OHSU). This is a two year K30 (NIH) sponsored program for the purposes of developing patient-oriented research skills. Mentored research will be conducted under the direction of a mentorship committee composed of Dr. Cynthia Morris, Professor of Medical Informatics and Outcomes Research, OHSU, Dr. David Lieberman, Chief, Division of Gastroenterology, OHSU, and Dr. John Hunter, Chairman, Department of Surgery, OHSU. Dr. Jeffrey Peters from the University of Southern California will serve as an off-site mentor and committee member. The proposed research focuses on improving risk stratification for esophageal adenocarcinoma. The fact that most patients are unaware of the presence of Barrett's esophagus prior to cancer diagnosis and because a large proportion of these patients never develop heartburn or reflux, suggests that the current GERD symptom-based screening paradigm may be inadequate. We theorize that patients with extraesophageal reflux symptoms are at risk for unrecognized esophageal injury and thus Barrett's esophagus. We hypothesize that endoscopic screening of patients with extraesophageal reflux symptoms will reveal a significantly higher prevalence of Barrett's esophagus when compared to patients without symptoms of gastroesophageal reflux. The primary aim is to establish that patients with extraesophageal reflux symptoms who are referred to an otolaryngology clinic have a prevalence of Barrett's metaplasia equivalent to that of a population with GERD symptoms. A secondary aim is to establish that in-office unsedated small-caliber endoscopy is accurate and acceptable to patients when employed within a screening program for Barrett's esophagus.