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Risk factors for Barrett’s esophagus among patients with gastroesophageal reflux disease: A community clinic-based case-control study

Edelstein, Zoe R. and Bronner, Mary P. and Rosen, Sheldon N and Vaughan, Thomas L. (2009) Risk factors for Barrett’s esophagus among patients with gastroesophageal reflux disease: A community clinic-based case-control study. American Journal of Gastroenterology, 104 (4). pp. 834-842. ISSN 0002-9270

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Objective: To measure the relative risks of Barrett’s esophagus (BE) associated with demographic factors, measures of adiposity and smoking among patients with gastroesophageal reflux disease (GERD). Methods: Patients newly diagnosed with specialized intestinal metaplasia (SIM) (n=197) were compared to patients with GERD (n= 418) in a community clinic-based case-control study. Case sub-groups included those with any visible columnar epithelium (VBE) (n=97), and those with a long segment (=2cm) of columnar epithelium (LSBE) (n=54). Results: Risks increased with older age (adjusted odds ratio (aOR) per decade for SIM=1.3, 95% confidence interval (CI)= 1.1-1.5; VBE aOR=1.4 ,CI=1.1-1.6; LSBE aOR=1.5, CI=1.2-1.9), male gender (SIM aOR=1.5, CI=1.1-2.2; VBE aOR=2.7, CI=1.6-4.5; LSBE aOR=3.9, CI=1.9- 8.1) and possibly Asian race. Increased risk of BE in particular was observed with high waist-tohip ratio (WHR, male high: =0.9, female high: =0.8) (SIM aOR=1.3, CI=0.9-2.1; VBE aOR=1.9, CI=1.0-3.5; LSBE aOR=4.1, CI=1.5-11.4). These associations were independent of body mass index (BMI) for the VBE and LSBE case groups but not for SIM which was the only case group in which BMI was a significant risk factor. Ever smoking cigarettes increased risk similarly for all case groups (SIM aOR=1.8, CI=1.2-2.6; VBE aOR=1.6, CI=1.0-2.6; LSBE aOR=2.6, CI=1.3- 4.9), although dose response relationship was not detected for duration or intensity of smoking. Conclusions: Older age, male gender and history of smoking increased risk of SIM and BE among GERD patients independent of other risk factors for BE. Central adiposity was most strongly related to risk of VBE and LSBE. These results may be useful in development of risk profiles for screening GERD patients.

Item Type: Article or Abstract
Additional Information: This article is available to subscribers only via the URL above
DOI: 10.1038/ajg.2009.137
PubMed ID: 19319131
PMCID: PMC2714477
Grant Numbers: R01 CA072866-04, K05 CA124911-02
Keywords or MeSH Headings: MH - Adult MH - Age Distribution MH - Aged MH - Aged, 80 and over MH - Barrett Esophagus/*epidemiology/etiology/pathology MH - Body Mass Index MH - Confidence Intervals MH - Female MH - Gastroesophageal Reflux/*complications/epidemiology/pathology MH - Humans MH - Intestinal Mucosa/pathology MH - Male MH - Middle Aged MH - Odds Ratio MH - Precancerous Conditions MH - Retrospective Studies MH - Risk Factors MH - Sex Distribution MH - Smoking/adverse effects/epidemiology MH - Washington/epidemiology MH - Young Adult
Subjects: Diseases > Solid tumors > Digestive system cancer
Research Methodologies > Epidemiology > Risk assessment
Depositing User: Library Staff
Date Deposited: 03 Apr 2009 21:44
Last Modified: 14 Feb 2012 14:42

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