Trajectories of endoscopic Barrett esophagus: Chronological changes in a community-based cohort.
OBJECTIVE
To elucidate longitudinal changes of an endoscopic Barrett esophagus (BE), especially of short segment endoscopic BE (SSBE).


METHODS
This study comprised 779 patients who underwent two or more endoscopies between January 2009 and December 2015. The intervals between the first and the last endoscopy were at least 6 mo. The diagnosis of endoscopic BE was based on the criteria proposed by the Japan Esophageal Society and was classified as long segment (LSBE) and SSBE, the latter being further divided into partial and circumferential types. The potential background factors that were deemed to affect BE change included age, gender, antacid therapy use, gastroesophageal reflux disease-suggested symptoms, esophagitis, and hiatus hernia. Time trends of a new appearance and complete regression were investigated by Kaplan-Meier curves. The factors that may affect appearance and complete regression were investigated by χ(2) and Student-t tests, and multivariable Cox regression analysis.


RESULTS
Incidences of SSBE and LSBE were respectively 21.7% and 0%, with a mean age of 68 years. Complete regression of SSBE was observed in 61.5% of initial SSBE patients, while 12.1% of initially disease free patients experienced an appearance of SSBE. Complete regressions and appearances of BE occurred constantly over time, accounting for 80% and 17% of 5-year cumulative rates. No LSBE development from SSBE was observed. A hiatus hernia was the only significant factor that facilitated BE development (P = 0.03) or hampered (P = 0.007) BE regression.


CONCLUSIONS
Both appearances and complete regressions of SSBE occurred over time. A hiatus hernia was the only significant factor affecting the BE story.
Shouji Shimoyama, Toshihisa Ogawa, Toshiyuki Toma, Gastrointestinal Unit, Settlement Clinic, Adachi-ku, Tokyo 120-0003, Japan.
Shouji
S
Shimoyama
Shouji Shimoyama, Toshihisa Ogawa, Toshiyuki Toma, Gastrointestinal Unit, Settlement Clinic, Adachi-ku, Tokyo 120-0003, Japan.
Toshihisa
T
Ogawa
Shouji Shimoyama, Toshihisa Ogawa, Toshiyuki Toma, Gastrointestinal Unit, Settlement Clinic, Adachi-ku, Tokyo 120-0003, Japan.
Toshiyuki
T
Toma
D000328:Adult; D001471:Barrett Esophagus / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods*; D004941:Esophagitis / Q000150:complications*; D004947:Esophagus / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D006551:Hernia, Hiatal / Q000150:complications; D006801:Humans; D015994:Incidence; D007564:Japan; D008137:Longitudinal Studies; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012044:Regression Analysis
Barrett esophagus; Hiatus hernia; Longitudinal vessels; Progression; Regression
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