The Impact of Recent Developments in the Management of GERD: A Retrospective Cohort Study
Bibliographic record
Abstract
Purpose: Recent developments may alter the approach to patients presenting with gastro-esophageal reflux (GERD)-like symptomatology. A recently proposed revised histological definition of Barrett's esophagus (Vakil et al. 2006) includes all types of esophageal columnar metaplasia, with or without intestinal type metaplasia. Also, adult eosinophilic esophagitis may be more prevalent than previously recognized in patients with GERD-like symptomatology. The aim of this study was to quantify the impact of these contemporary realizations on a general Gastroenterology multi-physician practice. Methods: All patients having a gastroscopy for an indication of GERD-type symptoms over a 1-year period ending November 2006 were considered. Patients were excluded if they had had a previous gastroscopy. Medical charts and endoscopic reports were retrospectively reviewed, while prospective audits of all available endoscopic images (grading of esophagitis and endoscopically suspected esophageal metaplasia (ESEM)) and esophageal biopsies were performed using standardized preset criteria. Results: A total of 353 patients fulfilled the study criteria. Typical symptoms of heartburn and regurgitation were found in 87.7% of patients and 23.2% of patients respectively. In addition, atypical chest pain was found in 4.2% of patients, dysphagia in 9.4% of patients, nocturnal symptoms in 11.3% of patients, sleep disturbance in 2.9% of patients, asthma in 1.3% of patients, cough in 2.6% of patients, and hoarseness in 5.5% of patients. 26% of patients were found to have erosive esophagitis at endoscopy, and 11.6% had ESEM. Histological evaluation was available for 65 patients (18.4%). 13.8% of these patients met traditional criteria for Barrett's, exhibiting intestinal-type metaplasia. In contrast, 73.8% of these patients fulfilled the proposed new consensus definition of Barrett's. Five patients (7.6%) met study criteria for eosinophilic esophagitis (>20 eosinophils/hpf), 4 of whom had not been recognized on the initial pathology report. Conclusion: GERD is an evolving clinical entity. Amongst patients presenting with typical GERD symptoms, the prevalence of Barrett's esophagus, using a revised definition, may increase markedly (over 5 fold increase in this study). In addition, awareness of an overlap with eosinophilic esophagitis may lead to an increase in the prevalence of this diagnosis. Prospective studies of the management implications of these findings are warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".