Epidemiologic Risk Factors in a Comparison of a Barrett Esophagus Registry (BarrettNET) and a Case-Control Population in Germany.

Melissa Schmidt,Andreas Lehmann,Michael Quante,Roland M Schmid,Julia Slotta-Huspenina,Yiyao Chen,Julia Horstmann,Anne S Quante,Birgit Linkohr,Donna P Ankerst,Karl-Friedrich Becker,Maria Wiethaler,Florian Kohlmayer,Konstantin Strauch

doi:10.1158/1940-6207.capr-19-0474

Abstract

Endoscopic screening for Barrett's esophagus as the major precursor lesion for esophageal adenocarcinoma is mostly offered to patients with symptoms of gastroesophageal reflux disease (GERD). However, other epidemiologic risk factors might affect the development of Barrett's esophagus and esophageal adenocarcinoma. Therefore, efforts to improve the efficiency of screening to find the Barrett's esophagus population "at risk" compared with the normal population are needed. In a cross-sectional analysis, we compared 587 patients with Barrett's esophagus from the multicenter German BarrettNET registry to 1976 healthy subjects from the population-based German KORA cohort, with and without GERD symptoms. Data on demographic and lifestyle factors, including age, gender, smoking, alcohol consumption, body mass index, physical activity, and symptoms were collected in a standardized epidemiologic survey. Increased age, male gender, smoking, heavy alcohol consumption, low physical activity, low health status, and GERD symptoms were significantly associated with Barrett's esophagus. Surprisingly, among patients stratified for GERD symptoms, these associations did not change. Demographic, lifestyle, and clinical factors as well as GERD symptoms were associated with Barrett's esophagus development in Germany, suggesting that a combination of risk factors could be useful in developing individualized screening efforts for patients with Barrett's esophagus and GERD in Germany.

Highlights

The incidence of esophageal adenocarcinoma is rapidly increasing in the western populations [1, 2] and Barrett's esophagus, a metaplastic transformation of the normal squamous mucosa of the distal esophagus to columnar epithelium, Note: Supplementary data for this article are available at Cancer Prevention Research Online.A.S
Barrett's esophagus only develops in up to 10% of patients with gastroesophageal reflux disease (GERD) [6], and only a fraction of patients with Barrett's esophagus develop esophageal adenocarcinoma [7], raising an economic and medical question of whom to screen by endoscopy
Patients with a history of cancer (n 1⁄4 51) were excluded. Controls for this analysis were chosen from the KORA FF4 (KORA: Cooperative Health Research in the Region of Augsburg) study, which is the second follow-up of the populationbased KORA S4 cohort examined between June 2013 and September 2014

Summary

Introduction

The incidence of esophageal adenocarcinoma is rapidly increasing in the western populations [1, 2] and Barrett's esophagus, a metaplastic transformation of the normal squamous mucosa of the distal esophagus to columnar epithelium, Note: Supplementary data for this article are available at Cancer Prevention Research Online (http://cancerprevres.aacrjournals.org/). The incidence of Barrett's esophagus has increased over the past decades, resulting in a large number of individuals “at risk” for esophageal adenocarcinoma. Frequent and severe gastroesophageal reflux disease (GERD) symptoms are thought to be a primary risk factor for the development of Barrett's esophagus [4, 5]. Barrett's esophagus only develops in up to 10% of patients with GERD [6], and only a fraction of patients with Barrett's esophagus develop esophageal adenocarcinoma [7], raising an economic and medical question of whom to screen by endoscopy

Methods

Results

Conclusion