title: Epidemiology and natural history of intestinal metaplasia of the gastroesophageal junction and Barrett's esophagus: a population-based study.
abstract: OBJECTIVE
  Population-based data on the epidemiology and outcomes of subjects with intestinal metaplasia of the gastroesophageal junction (IMGEJ) and Barrett's esophagus (BE) are limited. The objectives of this study were to (i) estimate the incidence of IMGEJ and BE diagnosed from clinically indicated endoscopy in Olmsted County, MN, over three decades (1976-2006) and prevalence as of 1 January 2007, (ii) compare baseline characteristics of subjects with IMGEJ and BE, and (iii) study the natural history and survival of both cohorts.
  
  
  METHODS
  This was a population-based cohort study. The study setting was Olmsted County, MN. Patients with BE (columnar segment >1 cm with intestinal metaplasia) and IMGEJ (intestinal metaplasia in biopsies from the gastroesophageal junction) from 1976 to 2006 in Olmsted County, MN, were identified using Rochester Epidemiology Project resources. Demographic and clinical data were abstracted from medical records and pathology confirmed by gastrointestinal pathologists. The association of baseline characteristics with overall and progression-free survival was assessed using proportional hazards regression models. Outcome measures were baseline characteristics and overall survival of subjects with IMGEJ compared to those with BE.
  
  
  RESULTS
  In all, 487 patients (401 with BE and 86 with IMGEJ) were identified and followed for a median interval of 7 (BE subjects) to 8 (IMGEJ subjects) years. Subjects with BE were older, heavier, reported reflux symptoms more often, and had higher prevalence of advanced neoplasia than those with IMGEJ. No patient with IMGEJ progressed to esophageal adenocarcinoma (EAC) in contrast to BE subjects who had a cumulative risk of progression of 7% at 10 years and increased risk of death from EAC (standardized mortality ratio 9.62). The overall survival of subjects with BE and IMGEJ did not differ from that expected in similar age- and sex-distributed white Minnesota populations.
  
  
  CONCLUSIONS
  Subjects with IMGEJ appear to have distinct clinical characteristics and substantially lower cancer progression risk compared to those with BE.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Kee Wook
authors.initials: KW
authors.lastname: Jung
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Talley
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Romero
authors.forename: David A
authors.initials: DA
authors.lastname: Katzka
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Schleck
authors.forename: Alan R
authors.initials: AR
authors.lastname: Zinsmeister
authors.forename: Kelly T
authors.initials: KT
authors.lastname: Dunagan
authors.forename: Lori S
authors.initials: LS
authors.lastname: Lutzke
authors.forename: Tsung-Teh
authors.initials: TT
authors.lastname: Wu
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
authors.forename: Mary
authors.initials: M
authors.lastname: Frederickson
authors.forename: Debra M
authors.initials: DM
authors.lastname: Geno
authors.forename: G Richard
authors.initials: GR
authors.lastname: Locke
authors.forename: Ganapathy A
authors.initials: GA
authors.lastname: Prasad
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D015331:Cohort Studies; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000209:etiology; D004943:Esophagogastric Junction / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D049690:History, Ancient; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008679:Metaplasia / Q000453:epidemiology; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015995:Prevalence; D017678:Sex Distribution; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000209:etiology