title: Prediction of Barrett's esophagus among men.
abstract: OBJECTIVE
  Risk factors for Barrett's esophagus include gastroesophageal reflux disease (GERD) symptoms, age, abdominal obesity, and tobacco use. We aimed to develop a tool using these factors to predict the presence of Barrett's esophagus.
  
  
  METHODS
  Male colorectal cancer (CRC) screenees were recruited to undergo upper endoscopy, identifying newly diagnosed cases of Barrett's esophagus. Logistic regression models predicting Barrett's esophagus using GERD symptoms alone and together with abdominal obesity, tobacco use, and age were compared.
  
  
  RESULTS
  Barrett's esophagus was found in 70 (8.5%) of 822 CRC screenees. Mutually adjusting for other covariates, Barrett's esophagus was associated with weekly GERD (odds ratio (OR)=2.33, 95% confidence interval (CI)=1.34, 4.05), age (OR per 10 years=1.53, 95% CI=1.05, 2.25), waist-to-hip ratio (OR per 0.10=1.44, 95% CI=0.898, 2.32) and pack-years of cigarette use (OR per 10 pack-years=1.09, 95% CI=1.04, 1.14). A model including those four factors had a greater area under the receiver operating characteristics curve than did a model based on GERD frequency and duration alone (0.72 vs. 0.61, P<0.001), and it had a net reclassification improvement index of 19-25%.
  
  
  CONCLUSIONS
  The prevalence of Barrett's esophagus was substantial in our population of older overweight men. A model based on GERD, age, abdominal obesity, and cigarette use more accurately classified the presence of Barrett's esophagus than did a model based on GERD alone. Following validation of the tool in another population, its use in clinical practice might improve the efficiency of screening for Barrett's esophagus.
authors: Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan 48109, USA. jhr@umich.edu
authors: Joel H
authors: JH
authors: Rubenstein
authors: Hal
authors: H
authors: Morgenstern
authors: Henry
authors: H
authors: Appelman
authors: James
authors: J
authors: Scheiman
authors: Philip
authors: P
authors: Schoenfeld
authors: Laurence F
authors: LF
authors: McMahon
authors: Valbona
authors: V
authors: Metko
authors: Ellen
authors: E
authors: Near
authors: Joan
authors: J
authors: Kellenberg
authors: Tal
authors: T
authors: Kalish
authors: John M
authors: JM
authors: Inadomi
mesh_terms: D000367:Age Factors; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000209:etiology; D003430:Cross-Sectional Studies; D005764:Gastroesophageal Reflux / Q000150:complications*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000150:complications*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D049629:Waist-Hip Ratio