Methods: Currently employed individuals reporting chronic heartburnwere selected from US household mail survey participants. Worker pro-ductivity and absenteeism were measured using the validated Work Pro-ductivity and Activity Impairment Questionnaire for Patients with Symp-toms of Gastro-Oesophageal Reflux Disease (WPAI-GORD) and quality oflife was measured using the validated Quality of Life in Reflux andDyspepsia (QOLRAD) instrument. The worker productivity score (WPS),representing lost productivity due to GERD symptoms expressed as apercent of potential total productivity, was used as the overall measure ofcombined absenteeism and reduced productive time. QOLRAD scoreswere categorized into those with low, medium and high quality of life.Lower QOLRAD scores indicate that GERD symptoms have a greaterimpact on quality of life. The mean WPS score for each quality of lifecategory was calculated. Higher WPS scores indicate that symptoms arereducing overall productivity to a greater degree. Using a chi-square,patients were compared on the proportion within each quality of lifecategory reporting lost productivity.Results: A total of 1,025 employed individuals with GERD symptomswere interviewed. Those with reduced productivity were on average morelikely to be younger (p � 0.001) but were similarly distributed in genderand income to those without impaired productivity. There was an associ-ation between quality of life and worker productivity, revealing that re-duced quality of life was associated with reduced worker productivity (p �0.001). GERD sufferers with a low quality of life score had the highestmean WPS, (a 33% decrease in overall work productivity). Those with amedium quality of life score had a mean WPS of 14%, followed by a WPSof 2% for those with high quality of life. Patients in the lowest category ofquality of life had the highest percent (90%) of respondents reportingreduced productivity followed by those in the middle category (63.8% ofindividuals). Reduced productivity was reported by 21.8% of individualsmeasured with the highest quality of life.Conclusions: Decreased quality of life due to GERD is strongly associatedwith reduced worker productivity. This observed association helps tovalidate self-reported measures of impaired worker productivity associatedwith GERD. Thus, improving symptoms and quality of life of employeeswith GERD may reduce the overall costs to employers related to reducedproductivity.

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Treatment patterns, clinical outcomes, and resource utilizationassociated with sessile colorectal lesionsJane E. Onken1, Joelle Y. Friedman2, Sujha Subramanian3, TroySchmidt1, Joshua Malenbaum2 and Kevin A. Schulman2*.1Gastroenterology, Duke University Medical Center, Durham, NC,United States; 2Duke Clinical Research Institute, Durham, NC, UnitedStates; and 3Boston Scientific, Natick, MA, United States.

Purpose: Sessile colorectal polyps often present a diagnostic and thera-peutic challenge to the endoscopist. The goals of this study were to: (1)describe treatment patterns and clinical outcomes, (2) determine factorsassociated with referral to surgery, and (3) estimate healthcare resource usefor patients with sessile colorectal lesions.Methods: Using endoscopic and surgical databases, all patients withsessile colon lesions treated at a single academic center between 1997 and2000 were identified and their records reviewed. Patient demographic dataincluded age, sex, and race; polyp data included size, location, and histol-ogy (lesions T2 or greater were excluded). Number and type of procedure,procedure and anesthesia times, hospital length of stay (LOS), and com-plications were recorded. Costs were estimated using the hospital’s cost-accounting system. Bootstrapped 95% confidence intervals (95% CI) wereused to compare mean procedure and anesthesia times, and LOS. Multipleregression analysis was used to identify predictors of surgical referral.Results: 280 patients were eligible for analysis. Mean age was 67 years;61% were �65. Mean polyp size was 1.3cm (range: 0.2-6.0cm); 85% were�2.0cm, and 44% were located in the left colon. Ten patients had malig-nant polyps. 34% had �2 procedures, and 7% had �3; procedure number

increased with polyp size. The most common complications were: bleeding(2.5%), small bowel obstruction (1.4%), and infection (1%); 90% occurredpost-operatively, the risk increasing with age and polyp size. 24% of polyps1.1–2.0 cm and 68% of polyps 2.1–3.0 cm were eventually referred tosurgery. Referral to surgery was associated with polyp size and the pres-ence of carcinoma (adjusted RR and 95% CI, 5.88 (4.19–7.37) and 3.54(1.58–4.74), respectively). All patients treated endoscopically were dis-charged the same day. Surgery procedures took 88 minutes longer thannon-surgical procedures (95% CI, 74.43–102.42). Mean LOS for transanalsurgery was 3.74 days, for open resection 7.14 days, and for laparoscopicresection 5.56 days. Mean total cost of treatment was $2,038 (range:$153-$14,837); open surgical resection was the most expensive ($6,165) fol-lowed by laparoscopic resection ($5,522); piecemeal polypectomy was themost expensive endoscopic treatment ($892).Conclusions: (1) More than a third of sessile colorectal lesions in thisseries required �2 procedures to complete the resection. (2) Number ofprocedures, complication risk, and referral to surgery increased with polypsize. (3) Resource utilization, complications, and costs were significantlyhigher in the surgically treated patients.

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The impact of an educational program on health related quality oflife in patients with gastroesophageal reflux diseaseRicardo A. Perez, Brian van der Linden* and Mark Kasari.1Gastroenterology, University of Virginia School of Medicine Roanoke-Salem Program, Salem, Virginia, United States.

Purpose: Advances in the diagnosis and understanding of gastroesopha-geal reflux disease (GERD) have afforded the clinician with a number oftherapeutic options. Patient educational programs are becoming popular,and the management of simple lifestyle modifications is one approach toreflux disease. This study is designated to evaluate the impact of patienteducation on lifestyle modifications for GERD, and its effect on healthrelated quality of life.Methods: Forty patients were enrolled after completing a questionnaire onGERD symptoms and severity. A clinical symptom and severity index wasconstructed and lifestyle habits were recorded. The health related quality oflife (Medical Outcomes Study SF-36 Health Survey) was completed. Allthe above information was gathered at the beginning and end of a threemonth period. At the beginning of this period patients were randomizedinto three groups. One group received an educational program on GERD,a second group received a general educational program and a third groupreceived no educational program.

Any changes in medications were monitored during the study.The GERD educational program consisted of a ten minute audiovisual

presentation designed to explain the upper gastrointestinal anatomy, theetiology of GERD, lifestyle modifications, and the principles of GERDtherapy. Spousal/partner attendance was encouraged and noted. Within oneweek, patients received educational pamphlets summarizing the audiovi-sual material. A one-month follow up telephone call was conducted by anurse coordinator to provide further instruction on GERD. The GERDeducation group was also evaluated by a ten question multiple choiceexamination given before and after the audiovisual presentation and onconclusion of the study. The second group received a general educationalprogram in a similar format, including a 10-minute audiovisual presenta-tion and follow up pamphlets and phone call.Results: In the GERD education group, score for vitality and physicalfunctioning improved over a three month period, (Vitality 10.5 to 12.1,Physical functioning 18.5 to 20). Scores for the general education groupand for the no program group worsened over the three month period, (Gen.Ed Group: Vitality 12.6 to 11.7, Physical functioning 23 to 19; No ProgramGroup: Vitality 10.3 to 9.8, Physical functioning 19 to 14.8). There was nosignificant difference in medication changes between the groups.Conclusions: A well-structured educational program for GERD patientsmay improve health related quality of life.

S277AJG – September, Suppl., 2001 Abstracts