ICD 10 Documentation Specialty Introduction - ppt download | icd 10 esophagitis[/caption]
icd 10 esophagitis
The American Journal of Gastroenterology (2006) 101, 1193–1199; doi:10.1111/j.1572-0241.2006.00550.x
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ICD 10 Documentation Specialty Introduction - ppt download | icd 10 esophagitis[/caption]
Annmarie Lassen PhD1, Jesper Hallas DMSci2 and Ove B Schaffalitzky de Muckadell DMSci3
Reflux affection are awful prevalent, and patients with gastroesophageal acerbic abatement present in a advanced analytic spectrum, alignment from no affection to debilitating affection and from no abatement lesions through cutting esophagitis to astringent lesions such as Barrett's esophagus or esophageal admonishment (1,2,3,4,5,6,7). Thus, patients with abatement lesions such as esophagitis, stricture, ulcer, or Barrett's esophagus represent a subgroup of all patients with gastroesophageal acerbic reflux. There is no gold accepted for the assay of gastroesophageal abatement disease, and our ability of the accomplishments citizenry incidence, prevalence, and accustomed history of gastroesophageal abatement ache is dispersed (7).
As accustomed in several studies, the accident of esophageal adenocarcinoma is acerb added amid patients with Barrett's esophagus, with an accident of esophageal adenocarcinoma of 0.4–0.5% per year (8,9). Furthermore, four population-based case-control studies and one accomplice abstraction accept adumbrated that the accident of esophageal adenocarcinoma is added in patients with abatement ache (10,11,12,13,14). However, the addition of Barrett's esophagus to these accident estimates is alien (15,16).
The aim of the present abstraction was to appraisal the accident of diagnosed abatement lesions at the citizenry akin amid 1983 and 2002, to appraisal the cardinal of patients with ahead diagnosed esophagitis, and to appraisal the accident of esophageal adenocarcinoma amid patients with abatement lesions.
We retrieved abstracts from bristles ample population-based registers: The Accommodating Administrative Arrangement of Funen County, the Odense Pharmacoepidemiological Database, the Danish Blight Registry, the Danish National Anthology of Patients, and the Civil Allotment System. Abstracts were affiliated by the altered claimed identifier for all Danish citizens (17).
Since 1974, endoscopies performed in Funen Canton (population 470,000) accept been registered in the Accommodating Administrative Arrangement of Funen County, a absolute cyberbanking anthology of all procedures performed in the accessible health-care system. From 1983, added than 50%, and back 1989, added than 95% of all endoscopies performed in the canton accept been recorded. Anniversary almanac contains the date of endoscopy, the resultant diagnoses, and the being identifier. From 1974 to 1993, diagnoses were coded according to World Bloom Organization (WHO) all-embracing allocation of diseases (ICD-8), and from 1994 according to ICD-10. All annal of endoscopy and accompanying esophagitis diagnoses (including comestible admonishment and esophageal ulcer) (ICD-8: 53090 esophagitis, 53091 esophagitis with ulcerations, 53092 esophageal stricture, 53098 bleeding esophagitis; ICD-10: K209 esophagitis, K210 gastroesophageal abatement with esophagitis, K221 esophageal ulcer, K222 esophageal stricture) for the aeon were identified. Furthermore, all esophageal, gastric, and belly operations for the aeon were identified.
Since 1943, the Danish Blight Anthology has recorded all patients in Denmark with cancerous neoplasms (18). From this registry, we retrieved admonition on date, morphology, and assay of the belly or esophageal blight assay (ICD-7: 1501–1513) of any accommodating advised by endoscopy in Funen County.
The Danish National Anthology of Patients includes admonition on all accommodating discharges, acceptance dates, and procedures performed during assay in accessible actual hospitals in Denmark (19). Admonition apropos endoscopies performed in added genitalia of Denmark was retrieved from this registry.
Since 1990, prescriptions reimbursed in the Canton of Funen accept been registered in Odense University Pharmacoepidemiological Database (20). Abstracts accept been complete from 1992. Anniversary almanac contains the date of purchase, a abounding annual of the dispensed product, and the altered claimed allotment number. All prescriptions adored for H2-receptor antagonists (ATC cipher A02BA), and proton pump inhibitors (ATC cipher A02BC), amid 1990 and 2002 were identified. The dispensed quantities were bidding by use of the authentic circadian dosage (DDD) methods developed by the WHO Biologic Utilization Analysis Accumulation (21), application the 2003 adaptation (available at: http://www.whocc.no/atcddd).
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Data on birth, deaths, and clearing in and out of the canton for all capacity were acquired from the Danish Civil Allotment System.
We retrieved abstracts on all endoscopies performed amid January 1, 1983 and December 31, 2002 in Funen County. Patients were labeled as diagnosed with esophagitis from their aboriginal accident with endoscopic abatement lesions according to the Accommodating Administrative Arrangement of Funen County.
For anniversary agenda year, we estimated the accident as the cardinal of patients with first-time diagnosed esophagitis disconnected by the person-time aural all citizens in Funen Canton that gave acceleration to these events. All accident estimates were connected by sex and age in 10-yr groups to the 1998 citizenry in Funen County. Bodies who were registered citizens in Funen Canton by the end of anniversary agenda year amid 1993 and 2002, and who had esophagitis diagnosed either in the agenda year or in antecedent years were registered, and the admeasurement that adored one or added prescriptions on antisecretory medication aural the agenda year was calculated. The accident of patients with ahead diagnosed esophagitis was connected to the sex and age administration of the 1998 citizenry in Funen County. All 95% aplomb intervals (CIs) accompanying to agenda year were affected beneath the acceptance of a Poisson distribution. Time-related trend was activated by the nonparametric assay for trend declared by Cuzick (22).
We affiliated abstracts on all endoscopies performed amid January 1, 1983 and December 31, 2002 in Funen Canton to admonition in the Danish National Anthology of Patients. Endoscopies performed in capacity who had no antecedent almanac of endoscopy, and no antecedent annal on esophageal, gastric, or esophageal operations from 1974 until the base date, were labeled as aboriginal endoscopies. Markers for an esophagitis assay at aboriginal endoscopy were adjourned by use of a assorted logistic corruption archetypal with three predefined absolute variables: age (<50 yr, 50–69 yr and >70 yr), sex, and agenda year (1983–1987 vs 1988–1992, 1993–1997, and 1998–2002).
A gastroesophageal blight assay registered in the Danish Blight Anthology amid 1974 and 2002 was articular for all first-time endoscopy patients. All first-time endoscopy patients were followed to the date a gastroesophageal blight was registered, death, emigration, or December 31, 2002, whichever came first. Person-years were affected for patients with esophagitis diagnosed at the aboriginal endoscopy, and for patients who had no esophagitis diagnosed during follow-up. Patients who had abatement lesions diagnosed afterwards the aboriginal endoscopy supplied person-years afterwards esophagitis from the aboriginal endoscopy until esophagitis was diagnosed and person-years with esophagitis thereafter. As a cancerous bane ability be misdiagnosed as esophagitis, we afar all gastroesophageal cancers occurring aural 1 yr afterwards the aboriginal endoscopy and discounted aftereffect time accordingly.
The cardinal of esophageal adenocarcinomas diagnosed during aftereffect was compared with the cardinal of esophageal adenocarcinomas accepted on the base of the cardinal of adventure esophageal adenocarcinomas in Denmark in 1993–2002 (23), and the connected arrangement was affected (SIR = observed/expected cardinal of gastroesophageal cancers). We connected by sex and age in 10-yr bands, and 95% CIs were affected beneath the acceptance of a Poisson distribution.
To appraisal the hazard ratios for altered types of gastroesophageal cancers amid patients with esophagitis compared with patients advised by endoscopy afterwards diagnosed esophagitis, we acclimated a multivariate Cox's corruption assay including sex and age (<50 yr, 50–69 yr, 70 yr) as predefined absolute variables. The altered blight types were: esophageal adenocarcinoma (ICD-7 1501), blight of the cardia (ICD-7 1511), esophageal squamous blight (ICD-7 1500 and a histological assay of squamous carcinoma), added or nonspecified esophageal cancers (ICD-7 1500 and no histological assay of squamous carcinoma), and added belly cancers (ICD-7 1510, 1512, or 1513).
With the aim to abate the accident of misclassification and to appraise the access of Barrett's esophagus, annal of all patients with esophageal blight diagnosed added than 1 yr afterwards the aboriginal endoscopy were scrutinized. One accommodating with squamous blight was misclassified as adenocarcinoma, one accommodating with early-stage characterless blight was misclassified as squamous carcinoma, one accommodating with adenocarcinoma was registered as ambiguous cancer, and one accommodating with squamous blight was registered as ambiguous esophageal cancer. All patients were included in accordance with their histological diagnosis. A absolute of 11 patients had a assay of long-segment Barrett's esophagus at atomic 1 yr afore their blight diagnosis. Seven of these were histologically accepted with abdominal metaplasia in the esophagus and four had appropriate allegation of "areas with belly epithelia in the esophagus" with no biopsies performed (as Barrett's esophagus was declared and handled in the 1980s in our area). Three of these four cases were afterwards histologically confirmed.
Endoscopy annal of 100 about called patients diagnosed with esophagitis for the aboriginal time amid 1993 and 2002 were scrutinized. In 98 cases, the assay was accepted by declared esophageal erythema or erosions. Amid the 98 patients, 3 had histologically absolute Barrett's esophagus and 2 had esophageal adenocarcinoma.
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All analyses were performed by Stata (release 8; Stata Corporation, College Station, TX)
The abstraction was accustomed by the Danish Abstracts Protection Agency.
Between 1983 and 2002, 129,515 endoscopies were performed in 65,907 persons, of whom 13,419 had esophagitis diagnosed for the aboriginal time. Amid the 13,419 esophagitis patients, 73% were diagnosed at their aboriginal endoscopy performed in this county. At the time of assay the average age was 56 yr (range 0–96 yr), 58% were male, and 8% had comestible admonishment or esophageal ulcer.
The connected accident of patients with anew diagnosed esophagitis added from 0.7 per 1,000 bodies per year (95% CI 0.6–0.7) in 1983 to 2.4 per 1,000 bodies per year (95% CI 2.3–2.6) in 2002 ( p < 0.001). The accident was college amid males than amid females and added by age (Fig. 1). In 1993, 8.5 per 1,000 bodies (95% CI 8.3–8.8) in Funen Canton had a present or antecedent assay of esophagitis; this amount added to 18.3 per 1,000 bodies (95% CI 17.9–18.7) in 2002 ( p = 0.002). The accident of patients with ahead diagnosed esophagitis was college amid males than amid females and added with age (Fig. 2). The admeasurement of patients with ahead diagnosed esophagitis who adored one or added prescriptions for antisecretory medication added by agenda year from 0.48 in 1993 to 0.53 in 2002 ( p < 0.001).
In alongside to the accident of esophagitis, the amount of endoscopy added with age and time. With the aim to analyze accessible age and time abashing accompanying to amount of endoscopy, we articular a accomplice of all 61,774 patients who were advised by endoscopy for the aboriginal time amid 1983 and 2002. A absolute of 8,505 (14%) had esophagitis diagnosed at the aboriginal endoscopy. The likelihood of an esophagitis assay by a aboriginal endoscopy was college amid males than amid females (odds arrangement 1.55 [95% CI 1.48–1.62]), it was college for endoscopies performed amid 1998 and 2002 than for endoscopies performed amid 1983 and 1987 (1.41 [95% CI 1.31–1.51]), and it decreased hardly with age (0.98 [95% CI 0.93–1.03] in patients age-old 50–69 and 0.87 [95% CI 0.82–0.92] in patients age-old 70 yr compared with patients <50 yr) (Table 1).
Among all 61,774 capacity with a aboriginal endoscopy, 8,505 were diagnosed with esophagitis at the aboriginal endoscopy, 2,624 had esophagitis diagnosed afterwards the aboriginal endoscopy, and 50,645 had no esophagitis diagnosed. Afterwards exclusion of the aboriginal year of ascertainment afterwards the aboriginal endoscopy and the aboriginal assay of esophagitis, the accomplice provided 58,322 person-years of aftereffect in patients with esophagitis (mean 6.3 years/patient, ambit 0.0–19.0 years/patient, 46,500 person-years from patients diagnosed at aboriginal endoscopy, 11,822 person-years from patients diagnosed at a afterwards endoscopy) and 288,595 person-years in patients afterwards esophagitis (mean 6.8 years/patient, ambit 0.0–19.0 years/patient, 279,917 person-years from patients never diagnosed with esophagitis, 8,677 person-years from patients with esophagitis diagnosed at a afterwards endoscopy).
Among all patients with a aboriginal endoscopy, 2% (1,236/61,774) had a gastroesophageal blight diagnosed either at the aboriginal endoscopy or during the aboriginal year (228 esophageal adenocarcinomas, 236 cancers of the cardia, 203 squamous corpuscle esophageal carcinomas, 516 noncardia belly cancers, and 53 added or nonspecified esophageal cancers). These tumors were not counted in the consecutive analysis. In the afterward years, 15 cases of esophageal adenocarcinoma were empiric amid patients with esophagitis, and 17 amid patients afterwards esophagitis. The accepted cardinal of esophageal adenocarcinomas according to the Danish Blight Statistics in the two cohorts was 2.79 and 11.78, and the connected accident arrangement was 5.38 (95% CI 3.01–8.87) for patients with esophagitis and 1.44 (95% CI 0.84–2.31) for patients advised by endoscopy but afterwards esophagitis diagnosed. The cancers were diagnosed a average of 4.5 yr (range 1.7–14.5 yr) afterwards the aboriginal endoscopy, 72% (23/32) of the patients were male, and the average age was 67 yr (range 41–84 yr) at their aboriginal endoscopy, with no aberration amid patients with and afterwards esophagitis.
After exclusion of the aboriginal year of observation, the accident amount for esophageal adenocarcinoma was 26 per 100,000 person-years amid patients with diagnosed esophagitis compared with 6 per 100,000 person-years amid patients afterwards esophagitis (difference 20 per 100,000 person-years (95% CI 7–32) (Table 2). Amid esophagitis patients, those with comestible admonishment or esophageal abscess had a college accident of afterwards diagnosed esophageal adenocarcinoma than patients registered by an ambiguous esophagitis assay (86 per 100,000 person-years vs 22 per 100,000 person-years, awkward aberration 64 per 100,000 person-years [95% CI -34–161]).
The hazard of altered gastroesophageal cancers amid patients advised by endoscopy with and afterwards diagnosed esophagitis was evaluated by multivariate Cox's corruption analysis. The hazard of esophageal adenocarcinoma was college amid patients with esophagitis than amid patients afterwards (hazard arrangement (HR) = 3.79 [95% CI 1.89–7.62]), it was college amid males than amid females (HR = 3.08 [95% CI 1.41–6.72]), and it added with age (HR = 8.09 [95% CI 2.35–27.78] in patients age-old 50–69, and 18.13 [95% CI 5.05–65.11] in patients age-old 70 yr compared with patients <50 yr). Patients with esophagitis had N HR of 2.70 (95% CI 1.30–5.58) for blight of the cardia compared with patients without. HRs of esophageal squamous blight and of added esophageal malignancies did not alter from the amount of one, and HRs for added belly cancers were hardly beneath accord (Table 2).
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Diseases of esophagus stomach,duodenum | icd 10 esophagitis[/caption]
By chiral analysis of the annal of all patients with afterwards diagnosed esophageal adenocarcinoma we begin that 10 of the 15 blight patients with esophagitis and 1 of the 17 blight patients afterwards registered esophagitis had Barrett's esophagus diagnosed at atomic 1 yr afore blight was discovered.
In the present study, we begin that, at a citizenry level, the accident of patients with anew and ahead diagnosed esophagitis added by agenda year, age, and macho sex. The accident of esophageal adenocarcinoma amid patients with ahead diagnosed esophagitis was bristles times college than expected, but best of these cancers were accompanying to patients with Barrett's esophagus.
The backbone of this abstraction is the population-based accomplice architecture in a categorical citizenry in which we were able to analyze individuals and chase them over time (17). This provides the achievability to analyze a accomplice of patients who were advised by endoscopy for the aboriginal time. Our accomplice provided 346,916 person-years of aftereffect in patients with a categorical cachet of either ahead diagnosed or no diagnosed esophagitis. This is a altered all-embracing accomplice with around no accident of follow-up, and with up to 20 yr of aftereffect in alone patients. Still, the capital limitation is the baby cardinal of blight cases empiric during follow-up. Added limitations are the accessible access of abysmal confounding, the empiric design, and accident of misclassification. A antecedent validation of procedures registered in our arrangement showed that 193 of 200 registered first-time endoscopies were accepted (24). In the present study, we begin that 98 of 100 of the registered esophagitis diagnoses were correct. The Danish Blight Anthology has a abduction amount beyond 95% (18), and all cases were manually verified. However, we cannot exclude the achievability that a few blight patients were missed.
Reflux affection are awful accustomed in the population, but alone few of the appropriate bodies seek medical admonition (1,2,3,4). In our area, the prevalence of abatement affection amid bodies age-old 40–65 yr is 237 per 1,000 bodies (25). In 2002, the cardinal of patients with ahead diagnosed esophagitis was 18.3 per 1,000 persons. We do not apperceive whether the patients with ahead diagnosed esophagitis still had esophagitis or symptoms, but 51% adored one or added prescriptions for antisecretory medication in 2002. Antecedent studies of patients with endoscopy-positive abatement ache accept apparent that up to three abode still accept cogent anguish accompanying to gastroesophageal abatement ache added than 10 yr afterwards assay (26,27,28).
Some allegation in our abstraction may be difficult to interpret, back some of the measures depend on amount of endoscopy. Amid 1983 and 1989 not all outpatient dispensary endoscopies were registered, which ability aftereffect in a lower accident appraisal than in the afterward years. Patients who had esophagitis diagnosed alfresco the canton were not articular unless they afterwards had esophagitis diagnosed aural the county. We begin that the likelihood of an esophagitis assay amid aboriginal endoscopy capacity was hardly college in adolescent than in old patients. Back the endoscopy amount is abundant lower amid the young, this entails a lower accident of diagnosed esophagitis amid the young. It is believable that we would accept begin agnate incidences amid the adolescent and the old had the amount of endoscopy been according amid patients with accessible abatement ache in the altered age groups. Although we do not apperceive the prevalence of bodies with accessible abatement ache in the altered age groups, the ascertainment challenges the acceptance that the accurate accident of esophagitis increases with age, and illustrates the above access of endoscopy alternative belief on the appear accident and prevalence figures.
We begin that the accident of esophageal adenocarcinoma in patients with esophagitis was low (26 per 100,000 person-years), although it was bristles times college than expected. We additionally begin that the accident was college amid patients with complicated esophagitis than amid patients with an bearding esophagitis diagnosis. In population-based case-control studies it was begin that the accident of adenocarcinoma in either the esophagus or cardia is bifold greater, and the accident of esophageal adenocarcinoma is 2.7–7.7 times greater in patients with abatement affection (10,11,12,13). Furthermore, one group, in a accomplice study, has begin that the accident of esophageal adenocarcinoma is greater by a agency 6.3 amid patients with a hospital acquittal assay of gastroesophageal abatement ache (14). Like in our study, some studies accept accustomed a dose–response accord amid the severity of the abatement ache and the accident of esophageal adenocarcinoma, and accept begin a college accident of cardia blight but not esophageal squamous corpuscle blight amid esophagitis patients (10,11,12,14).
It charcoal cryptic whether or not patients with Barrett's esophagus annual for the added accident of esophageal adenocarcinoma in patients with acerbic abatement (15,16). In the Swedish case-control abstraction of patients with esophageal adenocarcinoma, it was begin that the accident was 7.7-fold greater in patients with abatement affection (10). Back cases that had absolute Barrett's esophagus were compared with cases afterwards Barrett's esophagus it was begin that the affiliation amid abatement affection and esophageal adenocarcinoma was appropriately strong. In contrast, a British accumulation appear that the accident of esophageal blight was acerb accompanying to Barrett's esophagus, and alone abominably accompanying to esophagitis or abatement affection in patients who had no assay of Barrett's esophagus (29). In the present study, we analyzed the connected accident arrangement and begin that accident of esophageal adenocarcinoma amid patients with esophagitis was 5.38 back the Barrett's-related blight cases were included, but with two out of three of the cancers accompanying to patients with ahead diagnosed Barrett's esophagus. Unfortunately, Barrett's esophagus had no specific coding in the ICD-8 and ICD-10 systems, but was commonly registered application an ambiguous esophagitis code. Therefore, we cannot exclude Barrett's patients systematically from our cohort, and the accident estimates are based on a accomplice of patients with esophagitis in which about 3% accept Barrett's esophagus.
In conclusion, we begin that the accident of patients with anew and ahead diagnosed esophagitis added by agenda year, age, and macho sex, but that the estimates were carefully accompanying to amount of endoscopy. The accident of esophageal adenocarcinoma was fivefold greater amid patients with diagnosed esophagitis, but best of these cancers assume accompanying to Barrett's esophagus.
Annmarie Lassen is sponsored by the Danish Analysis Council and Institute of Analytic Research, University of Southern Denmark. There is no added funding.
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