Dysplasia severity is associated with poor quality of life in patients with Barrett's esophagus referred for endoscopic eradication therapy

S. Han, R. Yadlapati, V. Simon, E. Ezekwe, D. S. Early, V. Kushnir, T. Hollander, B. C. Brauer, H. Hammad, S. A. Edmundowicz, M. Wood, N. J. Shaheen, R. V. Muthusamy, Srinadh Komanduri, S. Wani

Research output: Contribution to journalReview article

Abstract

Limited data exist regarding patient-reported outcomes and quality of life (QOL) experienced by patients with Barrett's esophagus (BE) referred for endoscopic eradication therapy (EET). Specifically, the impact of grade of dysplasia has not been explored. The purpose of this study is to measure patient-reported symptoms and QOL and identify factors associated with poor QOL in BE patients referred for EET. This was a prospective multicenter study conducted from January 2015 to October 2017, which included patients with BE referred for EET. Participants completed a set of validated questionnaires to measure QOL, symptom severity, and psychosocial factors. The primary outcome was poor QOL defined by a PROMIS score >12. Multivariable logistic regression analysis was performed to identify factors associated with poor QOL. In total, 193 patients participated (mean age 64.6 years, BE length 5.5 cm, 82% males, 92% Caucasians) with poor QOL reported in 104 (53.9%) participants. On univariate analysis, patients with poor QOL had lower use of twice daily proton pump inhibitor use (61.5% vs. 86.5%, P = 0.03), shorter disease duration (4.9 vs. 5.9 years, P = 0.04) and progressive increase in grade of dysplasia (high-grade dysplasia: 68.8% vs. 31.3%, esophageal adenocarcinoma: 75.5% vs. 24.5%, P < 0.001). Multivariate analysis demonstrated that high-grade dysplasia was independently associated with poor QOL (OR: 5.57, 95% CI: 1.05, 29.5, P = 0.04). In summary, poor QOL is experienced by the majority of patients with BE referred for EET and the degree of dysplasia was independently associated with poor QOL, which emphasizes the need to incorporate patient-centered outcomes when studying treatment of BE-related dysplasia.

Original languageEnglish (US)
JournalDiseases of the Esophagus
Volume32
Issue number1
DOIs
StatePublished - Jan 1 2019

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Barrett Esophagus
Quality of Life
Therapeutics
Proton Pump Inhibitors
Multicenter Studies
Adenocarcinoma
Multivariate Analysis
Logistic Models
Regression Analysis
Prospective Studies
Psychology

Keywords

  • Barrett's esophagus
  • Esophageal adenocarcinoma
  • Patient preferences
  • Quality of life

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Han, S. ; Yadlapati, R. ; Simon, V. ; Ezekwe, E. ; Early, D. S. ; Kushnir, V. ; Hollander, T. ; Brauer, B. C. ; Hammad, H. ; Edmundowicz, S. A. ; Wood, M. ; Shaheen, N. J. ; Muthusamy, R. V. ; Komanduri, Srinadh ; Wani, S. / Dysplasia severity is associated with poor quality of life in patients with Barrett's esophagus referred for endoscopic eradication therapy. In: Diseases of the Esophagus. 2019 ; Vol. 32, No. 1.
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title = "Dysplasia severity is associated with poor quality of life in patients with Barrett's esophagus referred for endoscopic eradication therapy",
abstract = "Limited data exist regarding patient-reported outcomes and quality of life (QOL) experienced by patients with Barrett's esophagus (BE) referred for endoscopic eradication therapy (EET). Specifically, the impact of grade of dysplasia has not been explored. The purpose of this study is to measure patient-reported symptoms and QOL and identify factors associated with poor QOL in BE patients referred for EET. This was a prospective multicenter study conducted from January 2015 to October 2017, which included patients with BE referred for EET. Participants completed a set of validated questionnaires to measure QOL, symptom severity, and psychosocial factors. The primary outcome was poor QOL defined by a PROMIS score >12. Multivariable logistic regression analysis was performed to identify factors associated with poor QOL. In total, 193 patients participated (mean age 64.6 years, BE length 5.5 cm, 82{\%} males, 92{\%} Caucasians) with poor QOL reported in 104 (53.9{\%}) participants. On univariate analysis, patients with poor QOL had lower use of twice daily proton pump inhibitor use (61.5{\%} vs. 86.5{\%}, P = 0.03), shorter disease duration (4.9 vs. 5.9 years, P = 0.04) and progressive increase in grade of dysplasia (high-grade dysplasia: 68.8{\%} vs. 31.3{\%}, esophageal adenocarcinoma: 75.5{\%} vs. 24.5{\%}, P < 0.001). Multivariate analysis demonstrated that high-grade dysplasia was independently associated with poor QOL (OR: 5.57, 95{\%} CI: 1.05, 29.5, P = 0.04). In summary, poor QOL is experienced by the majority of patients with BE referred for EET and the degree of dysplasia was independently associated with poor QOL, which emphasizes the need to incorporate patient-centered outcomes when studying treatment of BE-related dysplasia.",
keywords = "Barrett's esophagus, Esophageal adenocarcinoma, Patient preferences, Quality of life",
author = "S. Han and R. Yadlapati and V. Simon and E. Ezekwe and Early, {D. S.} and V. Kushnir and T. Hollander and Brauer, {B. C.} and H. Hammad and Edmundowicz, {S. A.} and M. Wood and Shaheen, {N. J.} and Muthusamy, {R. V.} and Srinadh Komanduri and S. Wani",
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Han, S, Yadlapati, R, Simon, V, Ezekwe, E, Early, DS, Kushnir, V, Hollander, T, Brauer, BC, Hammad, H, Edmundowicz, SA, Wood, M, Shaheen, NJ, Muthusamy, RV, Komanduri, S & Wani, S 2019, 'Dysplasia severity is associated with poor quality of life in patients with Barrett's esophagus referred for endoscopic eradication therapy' Diseases of the Esophagus, vol. 32, no. 1. https://doi.org/10.1093/dote/doy086

Dysplasia severity is associated with poor quality of life in patients with Barrett's esophagus referred for endoscopic eradication therapy. / Han, S.; Yadlapati, R.; Simon, V.; Ezekwe, E.; Early, D. S.; Kushnir, V.; Hollander, T.; Brauer, B. C.; Hammad, H.; Edmundowicz, S. A.; Wood, M.; Shaheen, N. J.; Muthusamy, R. V.; Komanduri, Srinadh; Wani, S.

In: Diseases of the Esophagus, Vol. 32, No. 1, 01.01.2019.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Dysplasia severity is associated with poor quality of life in patients with Barrett's esophagus referred for endoscopic eradication therapy

AU - Han, S.

AU - Yadlapati, R.

AU - Simon, V.

AU - Ezekwe, E.

AU - Early, D. S.

AU - Kushnir, V.

AU - Hollander, T.

AU - Brauer, B. C.

AU - Hammad, H.

AU - Edmundowicz, S. A.

AU - Wood, M.

AU - Shaheen, N. J.

AU - Muthusamy, R. V.

AU - Komanduri, Srinadh

AU - Wani, S.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Limited data exist regarding patient-reported outcomes and quality of life (QOL) experienced by patients with Barrett's esophagus (BE) referred for endoscopic eradication therapy (EET). Specifically, the impact of grade of dysplasia has not been explored. The purpose of this study is to measure patient-reported symptoms and QOL and identify factors associated with poor QOL in BE patients referred for EET. This was a prospective multicenter study conducted from January 2015 to October 2017, which included patients with BE referred for EET. Participants completed a set of validated questionnaires to measure QOL, symptom severity, and psychosocial factors. The primary outcome was poor QOL defined by a PROMIS score >12. Multivariable logistic regression analysis was performed to identify factors associated with poor QOL. In total, 193 patients participated (mean age 64.6 years, BE length 5.5 cm, 82% males, 92% Caucasians) with poor QOL reported in 104 (53.9%) participants. On univariate analysis, patients with poor QOL had lower use of twice daily proton pump inhibitor use (61.5% vs. 86.5%, P = 0.03), shorter disease duration (4.9 vs. 5.9 years, P = 0.04) and progressive increase in grade of dysplasia (high-grade dysplasia: 68.8% vs. 31.3%, esophageal adenocarcinoma: 75.5% vs. 24.5%, P < 0.001). Multivariate analysis demonstrated that high-grade dysplasia was independently associated with poor QOL (OR: 5.57, 95% CI: 1.05, 29.5, P = 0.04). In summary, poor QOL is experienced by the majority of patients with BE referred for EET and the degree of dysplasia was independently associated with poor QOL, which emphasizes the need to incorporate patient-centered outcomes when studying treatment of BE-related dysplasia.

AB - Limited data exist regarding patient-reported outcomes and quality of life (QOL) experienced by patients with Barrett's esophagus (BE) referred for endoscopic eradication therapy (EET). Specifically, the impact of grade of dysplasia has not been explored. The purpose of this study is to measure patient-reported symptoms and QOL and identify factors associated with poor QOL in BE patients referred for EET. This was a prospective multicenter study conducted from January 2015 to October 2017, which included patients with BE referred for EET. Participants completed a set of validated questionnaires to measure QOL, symptom severity, and psychosocial factors. The primary outcome was poor QOL defined by a PROMIS score >12. Multivariable logistic regression analysis was performed to identify factors associated with poor QOL. In total, 193 patients participated (mean age 64.6 years, BE length 5.5 cm, 82% males, 92% Caucasians) with poor QOL reported in 104 (53.9%) participants. On univariate analysis, patients with poor QOL had lower use of twice daily proton pump inhibitor use (61.5% vs. 86.5%, P = 0.03), shorter disease duration (4.9 vs. 5.9 years, P = 0.04) and progressive increase in grade of dysplasia (high-grade dysplasia: 68.8% vs. 31.3%, esophageal adenocarcinoma: 75.5% vs. 24.5%, P < 0.001). Multivariate analysis demonstrated that high-grade dysplasia was independently associated with poor QOL (OR: 5.57, 95% CI: 1.05, 29.5, P = 0.04). In summary, poor QOL is experienced by the majority of patients with BE referred for EET and the degree of dysplasia was independently associated with poor QOL, which emphasizes the need to incorporate patient-centered outcomes when studying treatment of BE-related dysplasia.

KW - Barrett's esophagus

KW - Esophageal adenocarcinoma

KW - Patient preferences

KW - Quality of life

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U2 - 10.1093/dote/doy086

DO - 10.1093/dote/doy086

M3 - Review article

VL - 32

JO - Diseases of the Esophagus

JF - Diseases of the Esophagus

SN - 1120-8694

IS - 1

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