Risk factors for the development of esophageal adenocarcinoma in Barrett's esophagus.
OBJECTIVE
To identify risk factors for esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus (BE).


METHODS
A hospital-based case-control study was performed in which 91 cases with EAC and 244 controls with histologically confirmed BE (>2 cm) with no dysplasia or low-grade dysplasia were included. Information on demographic, anthropometric, and lifestyle characteristics, physical activity levels, working posture, family history, gastroesophageal reflux disease (GERD) symptoms, and medication use was collected by questionnaire.


RESULTS
Cases more often were current smokers (odds ratio 3.7, 95% confidence interval 1.4-9.9), more often had a body mass index >25 assessed at age 20 (2.6, 1.2-5.5), and more frequently had been working in a stooped posture at age 20 (2.0, 1.1-3.9), compared to controls. In addition, cases less often experienced symptoms of heartburn (0.3, 0.2-0.5) and less frequently used proton pump inhibitors (0.1, 0.05-0.2), compared to controls, whereas use of nonsteroidal anti-inflammatory drugs/aspirin was more common among cases (1.8, 1.1-3.2). Cases more often were men, compared to controls (91%vs 67%, p < 0.001).


CONCLUSIONS
In patients with BE, the risk of EAC is related to risk factors for GERD, which is, however, asymptomatic. As these risk factors are common in Western countries, they are probably not helpful in individualization of surveillance intervals.
de Jonge
Pieter J F
PJ
Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Steyerberg
Ewout W
EW
Kuipers
Ernst J
EJ
Honkoop
Pieter
P
Wolters
Leonieke M M
LM
Kerkhof
Marjon
M
van Dekken
Horman
H
Siersema
Peter D
PD
D000230:Adenocarcinoma / Q000453:epidemiology / Q000473:pathology*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D000897:Anti-Ulcer Agents / Q000008:administration & dosage; D001471:Barrett Esophagus / Q000453:epidemiology / Q000473:pathology*; D015992:Body Mass Index; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004522:Educational Status; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011187:Posture; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D011795:Surveys and Questionnaires
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000897:Anti-Ulcer Agents