This application proposes a training program to develop Blair A. Jobe, MD into an independent clinician-scientist specializing in investigations of Barrett's esophagus and esophageal cancer. Dr. Jobe is a board certified General Surgeon with subspecialty training in laparoscopic and esophageal surgery. The mentored career development plan consists of a three-tiered approach: a didactic education resulting in a Masters in Clinical Investigation degree, a broad-based experiential learning program, and a mentored clinical research experience. The primary goal of this program will be for Dr. Jobe to achieve independence as a clinical investigator in all respects. Dr. Jobe is currently enrolled in the Human Investigations Program at Oregon Health and Science University (OHSU). This is a two year K30 (NIH) sponsored program for the purposes of developing patient-oriented research skills. Mentored research will be conducted under the direction of a mentorship committee composed of Dr. Cynthia Morris, Professor of Medical Informatics and Outcomes Research, OHSU, Dr. David Lieberman, Chief, Division of Gastroenterology, OHSU, and Dr. John Hunter, Chairman, Department of Surgery, OHSU. Dr. Jeffrey Peters from the University of Southern California will serve as an off-site mentor and committee member. The proposed research focuses on improving risk stratification for esophageal adenocarcinoma. The fact that most patients are unaware of the presence of Barrett's esophagus prior to cancer diagnosis and because a large proportion of these patients never develop heartburn or reflux, suggests that the current GERD symptom-based screening paradigm may be inadequate. We theorize that patients with extraesophageal reflux symptoms are at risk for unrecognized esophageal injury and thus Barrett's esophagus. We hypothesize that endoscopic screening of patients with extraesophageal reflux symptoms will reveal a significantly higher prevalence of Barrett's esophagus when compared to patients without symptoms of gastroesophageal reflux. The primary aim is to establish that patients with extraesophageal reflux symptoms who are referred to an otolaryngology clinic have a prevalence of Barrett's metaplasia equivalent to that of a population with GERD symptoms. A secondary aim is to establish that in-office unsedated small-caliber endoscopy is accurate and acceptable to patients when employed within a screening program for Barrett's esophagus.
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