OBJECTIVES: The American College of Radiology (ACR) recommends that polyps ≤5 mm in size not be reported on computed tomography (CT) colonography studies. Patients with 1 or 2 polyps 6-9 mm in size can be offered "CTC surveillance" in 3 years in lieu of polypectomy. The aim of the study was to determine the impact of ACR recommendations on resection of high-risk adenoma findings using an endoscopic polyp/histology database. METHODS: Excluding patients with inflammatory bowel disease (IBD) and polyposis, 10,034 patients underwent colonoscopy and 10,780 polyps were removed from 5,079 patients over a 5-year interval. High-risk adenoma findings were defined as an advanced adenoma (≥1 cm in size, high-grade dysplasia (HGD), or villous elements) or 3 or more adenomas of any size, per postpolypectomy surveillance recommendations. RESULTS: A total of 5,079 patients (51%) had at least 1 polyp, 2,907 (29%) had at least 1 adenoma, and 1,001 (10%) had high-risk adenoma findings, of these, 293 (29%) had either 3 adenomas ≤5 mm in size (n=267) or an advanced adenoma ≤5 mm in size (or both) and no polyp of any histology ≥6 mm in size. There were 774 patients with 1 or 2 polyps 6-9 mm in size and no polyps of any histology ≥10 mm in size. Of these patients 184 (18% of the patients with high-risk adenomas) had either 3 or more adenomas ≤9 mm in size (n= 149) or an advanced adenoma ≤9 mm in size (or both findings). There were 2,174 patients age ≥50 years with the primary indication of screening of whom 326 (15%) had high-risk adenoma findings. Of these, 108 (33%) had either ≥3 adenomas ≤5 mm in size or an advanced adenoma ≤5 mm in size and no polyps ≥6 mm in size. An additional 75 (23%) had no polyp ≥10 mm in size, 1 or 2 polyps 6-9 mm in size and ≥3 adenomas ≤9 mm in size or an advanced adenoma ≤9 mm in size. CONCLUSIONS: If computed tomographic colonography (CTC) rather than colonoscopy were used in this population, assuming 100% sensitivity of CTC for polyps ≥6 mm and ACR interpretation recommendations, then 29% of all patients and 33% of screening patients age ≥50 years with high-risk adenoma findings would be interpreted as normal, and an additional 18-23% of these groups with high-risk adenoma findings, respectively, could have polypectomy delayed at least 3 years.
Purpose: There are remarkably few recent studies describing the American epidemiology of H. pylori and dyspepsia. This project describes the incidence, clinical characteristics, and healthcare costs for H. pylori and dyspepsia in a regional managed care system. Methods: All adults age >18 years with a new H. pylori or dyspepsia-related utilization during the study period (January 1, 2005, to December 31, 2009) were identified using diagnosis, procedure and pharmacy claims from the Lovelace Health Plan. Individuals were identified as incident cases based on the earliest occurrence of one of the following: 1) a diagnosis of H. pylori; 2) a diagnosis related to a condition potentially caused by H. pylori; 3) a specific test or procedure for H. pylori; or 4) a prescription fill for a treatment therapy indicated for H. pylori. Conditions potentially caused by H. pylorii were gastric, duodenal, peptic, or gastrojejunal ulcer; dyspepsia; gastritis; or existence of abdominal signs/symptoms plus one of the other inclusionary events within the next 6 months. Incident cases were matched to controls based on age and sex. Results: We identified 8,398 incident cases. Incidence rates decreased over the 5-year study period, particularly among individuals over 55 (Table). Women had a consistently higher incidence throughout the study period. Persons with H pylori and dyspepsia had substantially more comorbid conditions than their matched controls, particularly diabetes (7.7% vs 5.1%), COPD (5.1% vs 2.9%), deficiency anemias (2.8% vs 1.0%), and psychoses (2.9% vs 1.1%). H. pylori and dyspepsia patients also had higher utilization rates per 100 than controls in all areas of service, including hospitalizations (13 vs 9), outpatient visits (454 vs 297), and laboratory tests (73 vs 47), resulting in total direct healthcare costs 44% higher than controls. For all, P<0.001.Table: Incidence rates per 1,000 enrolled members per yearConclusion: In this population, H. pylori and dyspepsia are very common, but incidence appears to be declining among older adults. Women are at substantially higher risk, which was an unexpected finding. H. pylori and dyspepsia patients have significantly higher prevalences of several comorbid diseases and much higher health services utilization and costs than controls. This research was funded by Aptalis Pharma, Inc, Bridgewater, NJ, USA. Disclosure: Dr. Mapel and Ms. Roberts received research support funding from Aptalis Pharma, Inc. to conduct the investigations described in this abstract. This research was supported by an industry grant from Aptalis Pharma, Inc. Bridgewater, NJ, USA.
Dyspepsia is among the most common complaints evaluated by gastroenterologists, but there are few studies examining its current epidemiology, evaluation, and costs. We examined these issues in a large managed care system in the Southwestern United States.We conducted a retrospective case-control analysis of adults with incident dyspepsia or a Helicobacter pylori-related condition in years 2006 through 2010 using utilization data. Medical record abstraction of 400 cases was conducted to obtain additional clinical information.A total of 6989 cases met all inclusion and exclusion criteria. Women had a substantially higher risk of dyspepsia than men (14 per 1000 per year vs 10 per 1000; p < .001), and the incidence of dyspepsia increased with age such that persons in their seventh decade had almost twice the risk of those aged 18-29. Hispanic persons had a significantly higher risk of dyspepsia and positive H. pylori testing. Dyspepsia cases had a higher prevalence of other chronic comorbidities than their matched controls. Dyspepsia patients had healthcare costs 54% higher than controls even before the diagnosis was made, and costs in the initial diagnostic period were $483 greater per person, but subsequent costs were not greatly affected. Among those aged 55 and younger, the "test and treat" approach was used in 53% and another 18% had an initial esophagogastroduodenoscopy, as compared to 47 and 27%, respectively, among those over the age of 55.Women and older adults have a higher incidence of dyspepsia than previously appreciated, and Hispanics in this region also have a higher risk. Current guidelines for dyspepsia evaluation are only loosely followed.
