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Volume 7, Issue 6 , Pages 613-623, June 2009

Health-Related Quality of Life in Patients With Barrett's Esophagus: A Systematic Review

Seth D. Crockett
- Center for Esophageal Diseases and Swallowing, Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
- Reprint requests Address requests for reprints to: Seth D. Crockett, MD, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, CB#7080, Chapel Hill, North Carolina 27599-7080. fax: (919) 843-2508
Quinn K. Lippmann
- Center for Esophageal Diseases and Swallowing, Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
Evan S. Dellon
- Center for Esophageal Diseases and Swallowing, Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
Nicholas J. Shaheen
- Center for Esophageal Diseases and Swallowing, Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina

published online 12 March 2009.

Background & Aims

Barrett's esophagus (BE) affects approximately 10% of patients with chronic gastroesophageal reflux disease (GERD). Patients with BE are at risk for reduced health-related quality of life (HRQoL) associated with GERD, in addition to the potential psychosocial stress of carrying a diagnosis of a premalignant condition with a risk of esophageal adenocarcinoma. We sought to systematically review the published literature on HRQoL of patients with BE.

Methods

We searched PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature for relevant clinical trials using a defined search strategy. We also manually searched relevant scientific meeting abstracts and related article bibliographies. Eligible articles were case series, cohort studies, or clinical trials that included one or more measures of HRQoL and/or quantitatively assessed burden of disease in patients with BE. Effect sizes were calculated when possible.

Results

Our initial search identified 95 articles. After 2 physician reviews, 25 articles met inclusion criteria. Data show that BE is associated with a significant decrement in HRQoL as measured by both generic and disease-targeted instruments. In addition, patients with BE are at risk for psychological consequences such as depression, anxiety, and stress, which may be related to their increased risk of esophageal adenocarcinoma. Compared with subjects with GERD alone or the general population, a diagnosis of BE also leads to increased health care use and spending.

Conclusions

BE compromises multiple facets of patients' quality of life. Physicians and researchers should incorporate patient-reported outcomes data including HRQoL measures when treating or studying patients with BE.

Abbreviations used in this paper: BE, Barrett's esophagus, CINAHL, Cumulative Index to Nursing and Allied Health Literature, EAC, Esophageal adenocarcinoma, ES, Effect sizes, GERD, Gastroesophageal reflux disease, GERD-HRQL, Gastroesophageal Reflux Health-Related Quality of Life, GIQLI, Gastrointestinal Quality-of-Life Index, HADS, Hospital Anxiety and Depression Scale, HRQoL, Health-related quality of life, PPI, Proton pump inhibitor, QOLRAD, Quality of Life in Reflux and Dyspepsia questionnaire, SF-36, Short form-36