Letter: future directions for epidemiological studies of Barrett's oesophagus.

Abstract

Risk factors have been identified for developing Barrett's oesophagus (BO). These factors include modifiable lifestyle habits such as smoking, diet, and obesity – especially central adiposity rather than a high body mass index (BMI). 1-4 Other factors include male gender, Caucasian race, advanced age, the presence of a hiatal hernia, and the presence and duration of heartburn and related gastro-oesophageal reflux (GER) symptoms.5-7 A genetic predisposition for developing BO is also likely.8 We also now know that patients with long segment BO (segment lengths ≥3 cm) have an increased risk for oesophageal adenocarcinoma.5 Additionally, the onset of GER symptoms at age <30 years may be a risk factor for BO and oesophageal adenocarcinoma.6 However, few studies have focused on lifestyle, obesity and symptomatology during BO patients’ young adulthood. Furthermore, having BO develop at a young age is concerning since it permits more time for this condition to progress to oesophageal adenocarcinoma.4 Thus, we propose new directions for research into BO, given the gaps in the literature. First, it is important to identify risk factors for long segment BO rather than just the development of BO. Next, it is unknown how a patient's health, BMI and lifestyle during young adulthood affect the odds of developing BO, affect BO length or the age when BO is diagnosed. We have recently conducted a study to answer some of these questions in 158 adult patients with a new diagnosis of BO.9 Here, hiatal hernia length was strongly correlated to BO length (see Figure 1) which augments a recent meta-analysis on this topic.10 We also observed large weight gains from young adulthood may cause an earlier onset of BO, but they do not correlate with BO length. Declaration of personal and funding interests: None.