Quality of life measures in dysplastic Barrett’s oesophagus are comparable to patients with non-dysplastic Barrett’s oesophagus and do not improve after endoscopic therapy

Abstract

ObjectiveBarrett’s oesophagus (BO) is a precursor lesion, via dysplastic phases, to oesophageal adenocarcinoma. Although overall risk from BO is low, it has been shown to adversely affect health-related quality of life (HRQOL). The aim was to compare dysplastic BO patients’ HRQOL pre-endoscopic therapy (pre-ET) and post-ET. The pre-ET BO group was also compared with other cohorts: non-dysplastic BO (NDBO), those with colonic polyps, gastro-oesophageal reflux disease (GORD) and healthy volunteers.DesignParticipants in the pre-ET cohort were recruited prior to their endotherapy and HRQOL questionnaires provided pre-ET and post-ET. Wilcoxon rank test was used to compare the pre-ET and post-ET findings. The Pre-ET group was compared to the other cohorts’ HRQOL results using multiple linear regression analysis.ResultsPre-ET group of 69 participants returned the questionnaires prior to and 42 post-ET. Both the pre-ET and post-ET group showed similar levels of cancer worry, despite the treatment. No statistical significance was found for symptoms scores, anxiety and depression or general health measures with the Short Form-36 (SF-36) Score. Education for the BO patients was overall lacking with many of the pre-ET group still reporting unanswered questions about their disease.The Pre-ET group was compared with NDBO group (N=379), GORD (N=132), colonic polyp patients (N=152) and healthy volunteers (N=48). Cancer worry was similar between the NDBO group and the Pre-ET group, despite their lower risk of progression. GORD patients had worse symptom scores from a reflux and heartburn perspective. Only the healthy group has significantly better scores in the SF-36 and improved hospital anxiety and depression scores.ConclusionThese findings suggest that there is a need to improve HRQOL for patients with BO. This should include improved education and devising-specific patient-reported outcome measures for BO to capture relevant areas of HRQOL in future studies.

Reviewing Barrett’s Esophagus

“…These medications are often the first-line treatment for Barrett's esophagus. Regular endoscopic surveillance is recommended for individuals with Barrett's esophagus to monitor for any changes in the esophageal lining and detect early signs of cancer depends on the severity of the condition [24,25].…”

Latest Advances in Endoscopic Detection of Oesophageal and Gastric Neoplasia

“…It is known that a diagnosis of Barrett's oesophagus carries a reduced health-related quality of life, and this likely includes worries about cancer risk, endoscopic surveillance, and symptom control. Endoscopic therapy for Barrett's dysplasia is not associated with improved quality-of-life measures, including when considering similar levels of cancer worry pre-and post-treatment [26]. There is a need to improve the health-related quality of life in Barrett's oesophagus.…”