Mortality associated with Barrett's esophagus and gastroesophageal reflux disease diagnoses-a population-based cohort study.
BACKGROUND
Patients with Barrett's esophagus have a much increased risk of esophageal adenocarcinoma but recent evidence suggests no increase in overall mortality. We have reexamined this surprising finding in a large, prospectively population-based cohort study.


METHODS
Cohorts of patients having Barrett's esophagus (n=1,677), esophagitis (n=6,392), simple reflux (n=6,328), and a standard reference cohort representing the general population in the United Kingdom (n=13,416) were selected from General Practice Research Database. The last three cohorts were matched to the Barrett's cohort by general practice, age, and sex. Mortality rates and hazard ratios with their 95% confidence intervals were calculated for deaths due to all causes and deaths due to all causes except esophageal cancer occurring beyond the first year of the follow-up.


RESULTS
A total of 1,725 deaths were analyzed including 49 deaths in subjects having esophageal cancer. Of 111 deaths in the Barrett's cohort, 13 (12%) were in subjects with esophageal cancer. Compared with the reference cohort, hazard ratios for all causes of death were 1.37 (1.12-1.66) for the Barrett's, 1.16 (1.02-1.32) for the esophagitis, and 1.16 (1.01-1.33) for the reflux cohorts. The corresponding figures for deaths due to all causes except esophageal cancer were 1.23 (1.00-1.51), 1.13 (0.99-1.30), and 1.15 (1.00-1.31). Of the excess mortality rates in the Barrett's, esophagitis, and reflux cohorts, at the most 45%, 20%, and 13%, respectively, could be attributed to esophageal cancer.


CONCLUSIONS
People with Barrett's esophagus and gastroesophageal reflux disease have higher mortality rates than the general population, and an increase in esophageal cancer risk accounts for less than half the excess mortality in Barrett's.
Solaymani-Dodaran
Masoud
M
University of Nottingham, Division of Epidemiology and Public Health, Medical School, Queen's Medical Centre, Nottingham, UK.
Logan
Richard F A
RF
West
Joe
J
Card
Tim
T
D000328:Adult; D000367:Age Factors; D000368:Aged; D001471:Barrett Esophagus / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D016022:Case-Control Studies; D002423:Cause of Death; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D005764:Gastroesophageal Reflux / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011230:Precancerous Conditions / Q000473:pathology*; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D006113:United Kingdom