Etiological difference between ultrashort- and short-segment Barrett's esophagus.
BACKGROUND
Barrett's esophagus has been divided into three categories based on the extent of the metaplasia: long-segment (LSBE), short-segment (SSBE), and ultrashort-segment Barrett's esophagus (USBE). While both LSBE and SSBE are thought to be induced by gastroesophageal reflux, the etiology of USBE is still unclear.


METHODS
We conducted a case-control study to identify the differences in the pathogenesis between SSBE and USBE in a hospital-based population. The endoscopic findings and clinical factors of 199 patients with short-segment endoscopically suspected esophageal metaplasia (SS-ESEM) and 317 patients with ultrashort-segment ESEM (US-ESEM) were compared with those of 199 and 317 age- and gender-matched patients without ESEM.


RESULTS
The severity of gastric mucosal atrophy was marginally associated with the presence of US-ESEM [odds ratio (OR) 1.20, 95% confidence interval (CI) 0.98-1.46, p = 0.08], but not with that of SS-ESEM. On the other hand, the presence of gallstones and that of severe reflux esophagitis were associated with the presence of SS-ESEM (OR 2.19, 95% CI 1.21-3.98; OR 1.72, 95% CI 1.08-2.75), but not with that of US-ESEM. Presence of gastric corpus atrophy without gallstones was associated with the presence of US-ESEM, but not with that of SS-ESEM.


CONCLUSIONS
Presence of gastric corpus atrophy was associated with an increased likelihood of the presence of US-ESEM, whereas the presence of gallstones was associated with an increased likelihood of the presence of SS-ESEM, suggesting difference in etiology between US- and SS-ESEM.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Juntaro
J
Matsuzaki
Hidekazu
H
Suzuki
Keiko
K
Asakura
Yoshimasa
Y
Saito
Kenro
K
Hirata
Toru
T
Takebayashi
Toshifumi
T
Hibi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000150:complications; D001471:Barrett Esophagus / Q000209:etiology* / Q000473:pathology*; D016022:Case-Control Studies; D004942:Esophagitis, Peptic / Q000150:complications; D005260:Female; D042882:Gallstones / Q000150:complications*; D005753:Gastric Mucosa / Q000473:pathology; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013270:Stomach / Q000473:pathology*; D055815:Young Adult