title: Rates and predictors of progression to esophageal carcinoma in a large population-based Barrett's esophagus cohort.
abstract: OBJECTIVE
  Rates of progression to esophageal adenocarcinoma in subjects with Barrett's esophagus (BE) are lower than previously estimated. Identification of predictors of progression will enable risk stratification of BE subjects, potentially making current surveillance programs more efficient. We aimed to assess the potential of demographic and lifestyle factors, obesity, and medications in predicting progression in BE.
  
  
  METHODS
  BE subjects were identified from the General Practice Research Database using validated diagnostic codes. BE subjects developing esophageal cancer (EC) 12 months after their index BE diagnosis were defined as progressors. Time-to-event analysis was used to assess the overall risk of progression to EC. Cox proportional hazards models and time-varying marginal structural models were used to assess predictors of progression.
  
  
  RESULTS
  Included in the analysis were 9660 BE patients. The mean age (SD) of the study subjects was 63 (13.5) years; 62.6% were men. One hundred three subjects (1.1%) progressed to EC. The mean (SD) follow-up since initial diagnosis was 4.8 (3.3) years. The incidence of EC was 2.23 per 1000 person-years of follow-up. Increasing age, male gender, and being overweight (body mass index, 25-29.9) were found to be independent predictors of progression. When time-varying models were used, proton pump inhibitor (PPI) and statin use were protective against progression.
  
  
  CONCLUSIONS
  In this large population-based cohort of patients with BE, increasing age, male gender, and being overweight predicted progression to EC, whereas PPI and statin use were protective against EC development. These factors may aid in developing a risk score to predict the risk of progression and chemopreventive strategies in patients with BE.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Krishnamoorthi
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Bijan
authors.initials: B
authors.lastname: Borah
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Herbert
authors.initials: H
authors.lastname: Heien
authors.affiliation: Arizona Center for Digestive Health, Gilbert, Arizona, USA.
authors.forename: Ananya
authors.initials: A
authors.lastname: Das
authors.affiliation: Division of Gastroenterology & Hepatology, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Amitabh
authors.initials: A
authors.lastname: Chak
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Prasad G
authors.initials: PG
authors.lastname: Iyer
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology*; D000367:Age Factors; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000453:epidemiology*; D015992:Body Mass Index; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000453:epidemiology*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology; D050177:Overweight / Q000453:epidemiology*; D016016:Proportional Hazards Models; D065840:Protective Factors; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D054328:Proton Pump Inhibitors; D008687:Metformin