GI tract

Risk prediction model validated for Barrett’s oesophagus

A risk prediction model for Barrett’s oesophagus developed by researchers in South Australia has been validated as having a higher sensitivity than previous models.

The risk prediction model was developed based on variables such as age, gender, individual history of hypertension, individual history of acid regurgitation, first-degree family history of reflux, number of alcoholic drinks per week, and BMI.

Internal modelling showed it appeared to be an accurate predictor of Barrett’s oesophagus, the researchers from the University of South Australia write in Clinical and Experimental Gastroenterology.

And when validated in an external model of  95 people with Barrett’s oesophagus and 636 individuals from the general population it also showed a reasonable performance.

Its area under the curve (AUC) was 0.83 and after minimising false positives and false negatives, the model achieved a sensitivity of 74% and a specificity of 73%.

The researchers said the model could potentially be used in primary care to identify individuals who are at potentially higher risk of Barrett’s oesophagus and who may benefit from endoscopy investigation.

They note that the model would perform better than current Barrett’s oesophagus screening recommendations, which suggest further investigation for men with chronic gastroesophageal reflux disease and two or more risk factors, including >50 years, central obesity, first-degree family history of Barrett’s oesophagus or oesophageal adenocarcinoma, a smoking history, and Caucasian race.

They note that Barrett’s oesophagus is the only known precursor to oesophageal adenocarcinoma, which has a very poor prognosis has a high mortality rate. And while screening for Barrett’s oesophagus is not cost-effective at the population level, targeted screening might be beneficial.

“If the model continues to perform well in prospective trials, it has the potential to improve the identification of patients at greater risk of having Barrett’s oesophagus,” they concluded.

“However, a prospective trial should be undertaken to investigate the application of the model within clinical practice,” they suggested.

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