Risk factors associated with Barrett's epithelial dysplasia.
OBJECTIVE
To elucidate risk factors associated with dysplasia of short-segment Barrett's esophagus (BE).


METHODS
A total of 151 BE patients who underwent endoscopic examination from 2004 to 2008 in Aoyama Hospital, Tokyo Women's Medical University, Japan and whose diagnosis was confirmed from biopsy specimens were enrolled in the study. BE was diagnosed based on endoscopic findings of gastric-appearing mucosa or apparent columnar-lined esophagus proximal to the esophagogastric junction. Dysplasia was classified into three grades - mild, moderate and severe - according to the guidelines of the Vienna Classification System for gastrointestinal epithelial neoplasia. Anthropometric and biochemical data were analyzed to identify risk factors for BE dysplasia. The prevalence of Helicobacter pylori (H. pylori) infection and the expression of p53 by immunohistological staining were also investigated.


RESULTS
Histological examination classified patients into three types: specialized columnar epithelium (SCE) (n = 65); junctional (n = 38); and gastric fundic (n = 48). The incidence of dysplasia or adenocarcinoma from BE of the SCE type was significantly higher than that of the other two types (P < 0.01). The univariate analysis revealed that sex, H. pylori infection, body weight, p53 overexpression, and low diastolic blood pressure (BP) were associated with BE dysplasia. In contrast, body mass index, waist circumference, metabolic syndrome complications, and variables related to glucose or lipid metabolism were not associated with dysplasia. Multivariate logistic analysis showed that overexpression of p53 [odds ratio (OR) = 13.1, P = 0.004], H. pylori infection (OR = 0.19, P = 0.066), and diastolic BP (OR = 0.87, P = 0.021) were independent risk factors for epithelial dysplasia in BE patients with the SCE type.


CONCLUSIONS
Overexpression of p53 is a risk factor for dysplasia of BE, however, H. pylori infection and diastolic BP inversely associated with BE dysplasia might be protective.
Mikiko Fujita, Yuri Nakamura, Saeko Kasashima, Maiko Furukawa, Ryoichi Misaka, Hikaru Nagahara, Department of Gastroenterology, Aoyama Hospital, Tokyo Women's Medical University, Tokyo 1070061, Japan.
Mikiko
M
Fujita
Mikiko Fujita, Yuri Nakamura, Saeko Kasashima, Maiko Furukawa, Ryoichi Misaka, Hikaru Nagahara, Department of Gastroenterology, Aoyama Hospital, Tokyo Women's Medical University, Tokyo 1070061, Japan.
Yuri
Y
Nakamura
Mikiko Fujita, Yuri Nakamura, Saeko Kasashima, Maiko Furukawa, Ryoichi Misaka, Hikaru Nagahara, Department of Gastroenterology, Aoyama Hospital, Tokyo Women's Medical University, Tokyo 1070061, Japan.
Saeko
S
Kasashima
Mikiko Fujita, Yuri Nakamura, Saeko Kasashima, Maiko Furukawa, Ryoichi Misaka, Hikaru Nagahara, Department of Gastroenterology, Aoyama Hospital, Tokyo Women's Medical University, Tokyo 1070061, Japan.
Maiko
M
Furukawa
Mikiko Fujita, Yuri Nakamura, Saeko Kasashima, Maiko Furukawa, Ryoichi Misaka, Hikaru Nagahara, Department of Gastroenterology, Aoyama Hospital, Tokyo Women's Medical University, Tokyo 1070061, Japan.
Ryoichi
R
Misaka
Mikiko Fujita, Yuri Nakamura, Saeko Kasashima, Maiko Furukawa, Ryoichi Misaka, Hikaru Nagahara, Department of Gastroenterology, Aoyama Hospital, Tokyo Women's Medical University, Tokyo 1070061, Japan.
Hikaru
H
Nagahara
D000368:Aged; D000886:Anthropometry; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology*; D001706:Biopsy; D001794:Blood Pressure; D015992:Body Mass Index; D001835:Body Weight; D004724:Endoscopy; D004935:Esophageal Diseases / Q000150:complications / Q000473:pathology*; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D016481:Helicobacter Infections / Q000150:complications; D006801:Humans; D007564:Japan; D050356:Lipid Metabolism; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism
C495901:TP53 protein, human; D016159:Tumor Suppressor Protein p53
Barrett’s esophagus; Dysplasia; Helicobacter pylori; Risk factors; p53