CLINICAL, PHYSICAL AND DEMOGRAPHIC FACTORS CAN PREDICT THE LENGTH OF BARRETTʼS ESOPHAGUS

Abstract

Purpose: The increased risk for cancer in patients with Barrett's esophagus is often cited as a driving force for endoscopic evaluation of patients with gastroesophageal reflux disease (GERD). Long-segment Barrett's esophagus (LSBE) conveys an increased risk for cancer compared to short-segment Barrett's (SSBE), but clinical factors that distinguish these patients are less well characterized. The aim of our study is to evaluate clinical and epidemio-logic factors that may help distinguish patients with GERD, SSBE and LSBE in a geographically and racially diverse group of patients. Methods: We prospectively evaluated patients with endoscopic and histo-logically confirmed SSBE (<3 cm) and LSBE (>3 cm), as well as a GERD cohort. Demographic and clinical features, medication usage, endoscopic appearance and histologic samples from 112 GERD, 40 SSBE and 45 LSBE patients from 2 sites were compared. Results: There was a higher percentage of men in the LSBE group as compared to the SSBE (p <0.025) and GERD group (p <0.05). There was a higher percentage of Caucasians in the Barrett's groups; but this difference was significant only when comparing LSBE to GERD patients (p <0.01). LSBE patients were taller than patients in the SSBE (p <0.025) and GERD groups (P <0.005). This remained significant even when adjusting for gender differences. LSBE patients were more likely to have gained weight in the preceding year than SSBE (p <0.025) and GERD patients (p <0.01). There was a trend towards a higher weight in the LSBE group over the SSBE and GERD groups although this was not statistically significant. Interestingly, the average BMI was 30 kg/m2 in all three groups. LSBE patients were more likely to have heartburn symptoms for greater than 10 years than SSBE (p <0.05) or GERD (p <0.01) patients, but neither severity of heartburn or frequency of symptoms was significantly different between the three groups. Overall, there was no significant differences between the SSBE and GERD patients. Age, tobacco or alcohol use, previous esophagitis, hiatal hernia or PUD, medical history or medication were not distinguishing factors between any of the groups. Conclusions: While several clinical, demographic and physical characteristics distinguish LSBE patients from those with SSBE and uncomplicated GERD, we found no differences between SSBE and GERD patients. Thus, clinical factors cannot be used as discriminative factors in designing screening guidelines.