Prevalence and Risk Factors for Barrett's Esophagus in Patients with GERD in Northern India; Do Methylene Blue-directed Biopsies Improve Detection of Barrett's Esophagus Compared the Conventional Method?

BACKGROUND The reported rates of Barrett's esophagus (BE) ranged from 2.6% to 23% in Indian patients with gastro-esophageal reflux disease (GERD) symptoms. The role of methylene blue chromoendoscopy during endoscopy, either for the diagnosis of Barrett's esophagus or for the detection of dysplasia and early cancer, remains controversial. Our study was designed to find out the endoscopic as well as histological prevalence of BE in India in a specified patient population affected by GERD, and whether methylene blue chromoendoscopy improves detection of specialized intestinal metaplasia in endoscopically suspected Barrett's esophagus in GERD patients. METHODS Three hundred and seventy eight patients with characteristic symptoms of GERD from Northern India were subjected to upper endoscopy. On endoscopic suspicion of columnar lined epithelium (CLE) either 4-quadrant conventional biopsies at 2 cm interval or Methylene Blue (MB) directed biopsies were obtained randomly. The two groups were compared for the detection of Specialized Intestinal Metaplasia (SIM), which was diagnosed if the intestinal goblet cells were present. RESULTS Out of 378 patients with GERD, 56 (14.81%) were suspected of CLE on endoscopy. After taking biopsy samples from the 56 patients, only 9 (2.38%) had specialized intestinal metaplasia on histopathological examination. Five (15.15%) patients in the conventional group and four (17.39%) patients in the chromoendoscopy group (p=0.55) were diagnosed as having BE. On univariate analysis the predictors of SIM were symptoms of reflux and length of CLE. CONCLUSION The prevalence of biopsy proven BE and CLE in Northern India was 2.38% and 14.81%, respectively in patients with symptoms of GERD. The results of MB directed biopsies were similar to conventional biopsies in detecting SIM.