title: Risk factors in the development of esophageal adenocarcinoma.
abstract: OBJECTIVE
  It is assumed that esophageal adenocarcinoma is the end result of a stepwise disease process that transitions through gastroesophageal reflux disease (GERD) and Barrett's esophagus. The aim of this study was to examine at what stage known risk factors exert their influence toward the progression to cancer.
  
  
  METHODS
  We enrolled 113 consecutive outpatients without GERD, 188 with GERD, 162 with Barrett's esophagus, and 100 with esophageal adenocarcinoma or high-grade dysplasia (HGD). All patients underwent a standard upper endoscopy and completed a standardized questionnaire about their social history, symptoms, dietary habits, and prescribed medications. We used adjusted logistic regression analysis to assess risk factors between each two consecutive disease stages from the absence of reflux disease to esophageal adenocarcinoma.
  
  
  RESULTS
  Overall, male gender, smoking, increased body mass index (BMI), low fruit and vegetable intake, duration of reflux symptoms, and presence of a hiatal hernia were risk factors for cancer/HGD. However, different combinations of risk factors were associated with different disease stages. Hiatal hernia was the only risk factor to be strongly associated with the development of GERD. For GERD patients, male gender, age, an increased BMI, duration of reflux symptoms, and presence of a hiatal hernia were all associated with the development of Barrett's esophagus. Finally, the development of cancer/HGD among patients with Barrett's esophagus was associated with male gender, smoking, decreased fruit and vegetable intake, and a long segment of Barrett's esophagus, but not with age, BMI, or a hiatal hernia.
  
  
  CONCLUSIONS
  While some risk factors act predominantly on the initial development of reflux disease, others appear to be primarily responsible for the development of more advanced disease stages.
authors.affiliation: Department of Gastroenterology, VA Medical Center, White River Junction, Vermont 05009, USA. heiko.pohl@dartmouth.edu
authors.forename: Heiko
authors.initials: H
authors.lastname: Pohl
authors.forename: Katharina
authors.initials: K
authors.lastname: Wrobel
authors.forename: Christian
authors.initials: C
authors.lastname: Bojarski
authors.forename: Winfried
authors.initials: W
authors.lastname: Voderholzer
authors.forename: Amnon
authors.initials: A
authors.lastname: Sonnenberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Rösch
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Baumgart
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D015992:Body Mass Index; D016022:Case-Control Studies; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology*; D005247:Feeding Behavior; D005260:Female; D005638:Fruit; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D005858:Germany / Q000453:epidemiology; D006551:Hernia, Hiatal / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000150:complications / Q000175:diagnosis; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D011795:Surveys and Questionnaires; D013997:Time Factors; D014675:Vegetables