In an attempt to understand the reasons for the development of dysplasia and adenocarcinoma in Barrett's mucosa, researchers at Veterans Affairs medical centers in Albuquerque, New Mexico, and Chicago, Illinois, USA, have carried out a study into the development of the disease.
Led by Dr Stephen J. Sontag, the researchers have attempted to characterize risk factors for the transition from Barrett's esophagus without dysplasia, to Barrett's esophagus with high-grade dysplasia or esophageal adenocarcinoma.
A group of 131 patients with high-grade dysplasia or esophageal adenocarcinoma were selected as case subjects.
A first population of 2170 patients without gastroesophageal reflux disease (GERD) and a second population of 1189 subjects with Barrett's esophagus were used as 2 control groups.
Logistic regression analyses were used to compare the risk factors associated with the occurrence of high-grade dysplasia or esophageal adenocarcinoma.
Patients with high-grade dysplasia or esophageal adenocarcinoma shared many characteristics with other severe forms of GERD, such as older age, male gender, and white ethnicity.
The length of Barrett's esophagus and the size of hiatus hernia increased the risk for both conditions.
Subjects with high-grade dysplasia and adenocarcinoma had more severe acid reflux than patients with other forms of GERD.
| Hiatus hernia size - increased the risk of high-grade dysplasia |
|American Journal of Gastroenterology |
Smoking and alcohol consumption were not found to have any effect on the risk of developing high-grade dysplasia or adenocarcinoma in those patients with Barrett's esophagus.
The authors conclude that high-grade dysplasia and esophageal adenocarcinoma seem to stem from an extreme and unfavorable combination of all risk factors that are generally held responsible for the development of GERD and Barrett's esophagus.