The incidence of adenocarcinoma in Barrett's esophagus in an institutionalized population.
OBJECTIVE
To ascertain the incidence rate of adenocarcinoma in Barrett's esophagus (ACE) in a stable population of 28,000 institutionalized intellectually disabled individuals (IDI) in whom the prevalence rate of Barrett's esophagus (BE) was previously estimated in a representative sample by 24 h pH monitoring and endoscopy, and in which all cases of ACE were ascertained over a 6-year period. These IDI do not smoke or drink alcohol and are known to have exceptionally high prevalence rates of gastro-esophageal reflux disease, and consequently of BE.


METHODS
A population comprising 52,038 person-years was observed and all cases of ACE were ascertained. On the basis of the representative sample, the percentage of this population with BE was estimated to be 10.8%. ACE incidence rates could then be estimated and compared with those found in a free-living BE cohort after correction for age and gender differences.


RESULTS
In IDI an incidence rate of ACE of 2.5/1000 person-years was found against 6.3/1000 person-years in the free-living BE cohort. However, the age distributions of the IDI and of the free-living BE cohort were very different, and after correction for this factor there was no significantly lower incidence rate of ACE in the IDI (relative risk, 0.79; P = 0.61).


CONCLUSIONS
This is the first reported incidence study of ACE in a stable, well-defined population. In contrast to squamous cell carcinoma, our findings suggest only a minor role for smoking and alcohol in the etiology of ACE.
van Blankenstein
Mark
M
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands. markvbla@xs4all.nl
Böhmer
Clarisse J M
CJ
Hop
Wim C J
WC
D000230:Adenocarcinoma / Q000150:complications / Q000453:epidemiology*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications / Q000453:epidemiology*; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007326:Institutionalization; D008607:Intellectual Disability / Q000150:complications; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011230:Precancerous Conditions / Q000150:complications / Q000453:epidemiology*; D017678:Sex Distribution