Validation and Extension of the Michigan Barretts Esophagus pREdiction Tool (M-BERET)

密歇根巴雷特食管预测工具 (M-BERET) 的验证和扩展

• 批准号: 9001810
• 负责人: JOEL H RUBENSTEIN
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-01-01 至 2018-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9001810
• 关键词: Accounting; Adult; Age; American; Anxiety; Barrett Esophagus; Central obesity; Cigarette; Clinical; Colon Carcinoma; Colonoscopy; Consensus; Development; Diagnosis; Discrimination; Dysplasia; Endoscopy; Enrollment; Esophageal; Esophageal Adenocarcinoma; Esophagogastroduodenoscopy; Esophagus; Frequencies; Funding; Future; Gastroenterologist; Gastroesophageal reflux disease; Goals; Guidelines; Heartburn; Incidence; Individual; Interleukin-6; Leptin; Lesion; Malignant Neoplasms; Malignant neoplasm of esophagus; Mental Depression; Mentored Patient-Oriented Research Career Development Award; Michigan; Modeling; National Institute of Diabetes and Digestive and Kidney Diseases; Neoplasms; Obesity; Patient Selection; Patient risk; Patients; Population; Premalignant; Probability; Proton Pump Inhibitors; Recommendation; Recruitment Activity; Research; Research Personnel; Retrospective Studies; Risk; Risk Factors; Symptoms; Tobacco; Tobacco use; United States; Validation; Veterans; Waist-Hip Ratio; Woman; Work; base; cancer diagnosis; circulating biomarkers; cohort; cost; cost effective; ghrelin; high risk; improved; male; medical specialties; men; mortality; neoplastic; patient population; personalized approach; psychological distress; public health relevance; response; screening; sex; tool

DESCRIPTION (provided by applicant): The incidence of esophageal adenocarcinoma in the United States has risen 6-fold over the last 4 decades. Barrett's esophagus is a change in the lining of the esophagus that is a precursor to the cancer. Major factors associated with both Barrett's Esophagus and esophageal adenocarcinoma are heartburn and regurgitation, which are symptoms of gastroesophageal reflux disease (GERD). Roughly 20% of Americans have GERD symptoms on a weekly basis, and over 2 million upper endoscopies are performed annually in the U.S. in adults with GERD symptoms. Nonetheless, fewer than 15% of patients with esophageal adenocarcinoma have had an upper endoscopy prior to their diagnosis of the cancer. Patients with GERD symptoms are more likely to be referred to upper endoscopy if their symptoms have responded inadequately to proton pump inhibitors (PPIs). Approximately 50% of such patients do not have abnormal amounts of gastroesophageal reflux accounting for their symptoms, and often have psychological distress characterized by features of somatization, anxiety and depression. Clearly, there is a need for improved selection of patients for endoscopic screening. A quick, personalized clinical tool for identifying men at risk for Barrett's esophagus has been developed, the Michigan Barrett's Esophagus pREdiction Tool (M-BERET). The proposed study aims to validate that tool in a clinical population, extend it to women, and to determine if inclusion of specific circulating biomarkers and/or features of psychological distress can improve its accuracy. The study will enroll consecutive patients undergoing their first endoscopy and compare the accuracy of the tool to GERD symptoms alone for predicting the presence of Barrett's esophagus. Patients referred for their first endoscopic treatment of Barrett's esophagus with high grade dysplasia or intramucosal cancer will also be enrolled, and the accuracy of the tool will be assessed for discriminating these patients from patients with non-dysplastic Barrett's esophagus and no Barrett's esophagus. The study will also compare the accuracy of the tool to GERD symptoms for predicting the incidence of esophageal adenocarcinoma in a large retrospective longitudinal cohort. If the personalized tool is validated in the proposed study and widely used, it is expected to improve the allocation of endoscopy, decreasing over-utilization in low-risk patients, and increasing utilization in high-risk patients, ultimately decreasing the burden of esophageal adenocarcinoma in an efficient manner.

描述（由申请人提供）：