title: Symptoms and endoscopic features at barrett's esophagus diagnosis: implications for neoplastic progression risk.
abstract: OBJECTIVE
  Risk stratification of Barrett's esophagus (BE) patients based on clinical and endoscopic features may help to optimize surveillance practice for esophageal adenocarcinoma (EAC) development. The aim of this study was to investigate patient symptoms and endoscopic features at index endoscopy and risk of neoplastic progression in a large population-based cohort of BE patients.
  
  
  METHODS
  A retrospective review of hospital records relating to incident BE diagnosis was conducted in a subset of patients with specialized intestinal metaplasia from the Northern Ireland BE register. Patients were matched to the Northern Ireland Cancer Registry to identify progressors to EAC or esophageal high-grade dysplasia (HGD). Cox proportional hazards models were applied to evaluate the association between endoscopic features, symptoms, and neoplastic progression risk.
  
  
  RESULTS
  During 27,997 person-years of follow-up, 128 of 3,148 BE patients progressed to develop HGD/EAC. Ulceration within the Barrett's segment, but not elsewhere in the esophagus, was associated with an increased risk of progression (hazard ratio (HR) 1.72; 95% confidence interval (CI): 1.08-2.76). Long-segment BE carried a significant sevenfold increased risk of progression compared with short-segment BE; none of the latter group developed EAC during the study period. Conversely, the absence of reflux symptoms was associated with an increased risk of cancer progression (HR 1.61; 95% CI: 1.05-2.46).
  
  
  CONCLUSIONS
  BE patients presenting with a long-segment BE or Barrett's ulcer have an increased risk of progressing to HGD/EAC and should be considered for more intense surveillance. The absence of reflux symptoms at BE diagnosis is not associated with a reduced risk of malignant progression, and may carry an increased risk of progression.
authors.affiliation: 1] Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland [2] These authors contributed equally to this work.
authors.forename: Helen G
authors.initials: HG
authors.lastname: Coleman
authors.affiliation: 1] Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland [2] These authors contributed equally to this work.
authors.forename: Shivaram K
authors.initials: SK
authors.lastname: Bhat
authors.affiliation: Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Liam J
authors.initials: LJ
authors.lastname: Murray
authors.affiliation: Belfast Health and Social Care Trust, Belfast, Northern Ireland.
authors.forename: Damian T
authors.initials: DT
authors.lastname: McManus
authors.affiliation: Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Orla M
authors.initials: OM
authors.lastname: O'Neill
authors.affiliation: Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
authors.forename: Anna T
authors.initials: AT
authors.lastname: Gavin
authors.affiliation: Belfast Health and Social Care Trust, Belfast, Northern Ireland.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Johnston
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis / Q000473:pathology*; D003661:Decision Support Techniques; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D011230:Precancerous Conditions / Q000175:diagnosis / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult