Characteristics of patients with columnar-lined Barrett's esophagus and risk factors for progression to esophageal adenocarcinoma.
OBJECTIVE
To determine the risk factors for the development of esophageal adenocarcinoma in these patients with columnar-lined esophagus (CLE).


METHODS
Data collected retrospectively on 597 consecutive patients diagnosed at endoscopy and histology to have CLE at Leeds General Infirmary between 1984 and 1995 were analyzed. Factors evaluated included age, sex, length of columnar segment, smoking, and drinking habits, history of non-steroidal ingestion, presence of endoscopic esophagitis, ulceration or benign strictures and presence of Helicobacter pylori in esophageal biopsies. Univariate and multivariate analyses were performed to identify risk factors for the development of adenocarcinoma.


RESULTS
Forty-four patients presented or developed esophageal adenocarcinoma during follow-up. Independent risk factors for the development of adenocarcinoma in patients with CLE were males (OR 5.12, 95%CI 2.04-12.84, P=0.0005), and benign esophageal stricture (OR 4.37, 95%CI 2.02-9.45, P=0.0002). Male subjects and patients who developed benign esophageal stricture constituted 86% (n=38) of all patients who presented or developed esophageal adenocarcinoma. The presence of esophagitis was associated with a significant reduction in the development of esophageal carcinoma (OR 0.28, 95%CI 0.13-0.57, P=0.0006). No other clinical characteristics differentiate between the non-malignant and malignant group.


CONCLUSIONS
In patients with CLE, endoscopic surveillance for the early detection of adenocarcinoma may be restricted to male subjects, as well as patients who develop benign esophageal strictures.
Bani-Hani
Kamal E
KE
Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, PO Box 3030, Jordan. banihani@yahoo.com
Bani-Hani
Bayan K
BK
Martin
Iain G
IG
D000230:Adenocarcinoma / Q000473:pathology* / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors