title: Erosive esophagitis is a risk factor for Barrett's esophagus: a community-based endoscopic follow-up study.
abstract: OBJECTIVE
  Symptomatic gastroesophageal reflux disease (GERD) is associated with a significantly increased risk of esophageal adenocarcinoma, but its natural history in the general population is poorly understood. Whether nonerosive reflux disease (NERD) is a risk factor for Barrett's esophagus (BE), the precursor of esophageal adenocarcinoma, is unknown. Furthermore, quantifying the risk of incident BE in those with untreated reflux esophagitis has not been possible. We aimed, in a prospective follow-up study with endoscopy, to evaluate the risk of BE in a cohort from the Swedish general population (the Kalixanda Study).
  
  
  METHODS
  Those with endoscopic or histological findings suggestive of GERD and randomly half of those with NERD (n=481) were invited for follow-up investigation including endoscopy and a validated symptom questionnaire 5 years after the initial study. Multinomial logistic regression was used to estimate relative risk ratios (RRRs) and 95% confidence intervals (CIs) for change in presentation of GERD.
  
  
  RESULTS
  Of the 405 subjects available for inclusion, endoscopy was performed in 284 (response rate 70.1%). The incidence of BE was 9.9/1,000 person-years. Of those with NERD at baseline (n=113), progression to erosive esophagitis was found in 11; 2 developed BE. Erosive esophagitis (n=90) progressed to a more severe grade in 12 and to BE in 8 cases. Erosive esophagitis at baseline was independently associated with BE at follow-up (RRR 5.2; 95% CI 1.2-22.9).
  
  
  CONCLUSIONS
  Compared with being free of GERD at follow-up, erosive esophagitis is a major risk factor for BE (with a fivefold increased risk) after 5 years in the general population.
authors.affiliation: Institute of Health Sciences, University of Oulu, Oulu, Finland. jukka.ronkainen@fimnet.fi
authors.forename: Jukka
authors.initials: J
authors.lastname: Ronkainen
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Talley
authors.forename: Tom
authors.initials: T
authors.lastname: Storskrubb
authors.forename: Sven-Erik
authors.initials: SE
authors.lastname: Johansson
authors.forename: Tore
authors.initials: T
authors.lastname: Lind
authors.forename: Michael
authors.initials: M
authors.lastname: Vieth
authors.forename: Lars
authors.initials: L
authors.lastname: Agréus
authors.forename: Pertti
authors.initials: P
authors.lastname: Aro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D018450:Disease Progression; D004941:Esophagitis / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology