title: Age at onset of GERD symptoms predicts risk of Barrett's esophagus.
abstract: OBJECTIVE
  Symptoms of gastroesophageal reflux disease (GERD) are the primary risk factor for Barrett's esophagus (BE). However, the significance of age at symptom onset is unknown. We examined the effects of multiple dimensions of GERD exposure on BE risk and whether these associations are modified by other risk factors for BE.
  
  
  METHODS
  Data were from a cross-sectional study of 683 Veterans Affairs patients undergoing an elective esophagogastroduodenoscopy (EGD) or a study EGD concurrently with colonoscopy from primary care clinics. We compared 236 patients with both endoscopically suspected and histologically confirmed BE to 447 primary-care patients ("primary-care controls") without endoscopically suspected BE on their study EGD. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariate logistic regression.
  
  
  RESULTS
  Age at onset <30 years of frequent (at least weekly) GERD symptoms was associated with highest risk of BE (OR=15.1, 95% CI 7.91-28.8), and risk increased linearly with earlier age at onset of symptoms (P-trend=0.001). This association was independent of cumulative GERD symptom duration. People with early onset GERD symptoms who reported ever using proton pump inhibitors were at especially high risk of BE (OR=31.1, 95% CI 13.9-69.7). In people with frequent GERD symptoms, BE risk was almost 80% lower among Helicobacter pylori-positive patients (OR=2.60, 95% CI 1.26-5.40) than those negative for H. pylori (OR=8.24, 95% CI 5.00-13.6).
  
  
  CONCLUSIONS
  Risk of BE increased linearly with earlier age at onset of frequent GERD symptoms. Age at symptom onset may help practitioners decide which patients with GERD symptoms to refer for endoscopic screening for BE.
authors.affiliation: Population Health Department, Queensland Institute of Medical Research, Brisbane, Queensland, Australia.
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Thrift
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kramer
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Qureshi
authors.forename: Peter A
authors.initials: PA
authors.lastname: Richardson
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D001471:Barrett Esophagus / Q000453:epidemiology*; D016022:Case-Control Studies; D002648:Child; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000453:epidemiology*; D016481:Helicobacter Infections / Q000453:epidemiology / Q000382:microbiology; D016480:Helicobacter pylori; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors