TY - JOUR
T1 - Hiatal hernia and acid reflux frequency predict presence and length of Barrett's esophagus
AU - Avidan, Benjamin
AU - Sonnenberg, Amnon
AU - Schnell, Thomas G.
AU - Sontag, Stephen J.
N1 - Funding Information:
This material is the result of work supported with resources and the use of facilities at the Hines VA Medical Center. Supported by a grant from the American Digestive Health Foundation.
PY - 2002
Y1 - 2002
N2 - One third of the general population may experience reflux symptoms, yet only a small fraction of patients with gastroesophageal reflux disease (GERD) have Barrett's esophagus. The aim of the present study was to compare the characteristics of GERD patients with and without Barrett's esophagus and identify potential risk factors for the appearance of Barrett's esophagus in reflux disease. Outpatients from a gastroenterology clinic who underwent upper gastrointestinal endoscopy, esophageal manometry, and 24-hr pH monitoring were recruited into a case-control study. A total of 256 case subjects with endoscopically and histologically proven Barrett's esophagus were compared to a control group of 229 subjects with nonerosive reflux disease. As compared to nonerosive reflux disease, Barrett's esophagus was strongly associated with more reflux episodes. Barrett's esophagus occurred more frequently among subjects with hiatus hernia and among subjects who consumed large amounts of alcohol or cigarettes. Frequent reflux episodes, hiatus hernia, smoking, and alcohol consumption were also risk factors for an increased length of Barrett's mucosa. Total esophageal mucosal acid contact time at pH < 4 was a significant risk factor for the length but not the presence of Barrett's esophagus. Intake of aspirin or NSAIDs was similar in patients with and without Barrett's esophagus. In conclusion, in comparison with nonerosive reflux disease, Barrett's esophagus is characterized by risk factors usually indicative of severe types of GERD. Mechanisms in addition to acid reflux must contribute to the development of Barrett's esophagus.
AB - One third of the general population may experience reflux symptoms, yet only a small fraction of patients with gastroesophageal reflux disease (GERD) have Barrett's esophagus. The aim of the present study was to compare the characteristics of GERD patients with and without Barrett's esophagus and identify potential risk factors for the appearance of Barrett's esophagus in reflux disease. Outpatients from a gastroenterology clinic who underwent upper gastrointestinal endoscopy, esophageal manometry, and 24-hr pH monitoring were recruited into a case-control study. A total of 256 case subjects with endoscopically and histologically proven Barrett's esophagus were compared to a control group of 229 subjects with nonerosive reflux disease. As compared to nonerosive reflux disease, Barrett's esophagus was strongly associated with more reflux episodes. Barrett's esophagus occurred more frequently among subjects with hiatus hernia and among subjects who consumed large amounts of alcohol or cigarettes. Frequent reflux episodes, hiatus hernia, smoking, and alcohol consumption were also risk factors for an increased length of Barrett's mucosa. Total esophageal mucosal acid contact time at pH < 4 was a significant risk factor for the length but not the presence of Barrett's esophagus. Intake of aspirin or NSAIDs was similar in patients with and without Barrett's esophagus. In conclusion, in comparison with nonerosive reflux disease, Barrett's esophagus is characterized by risk factors usually indicative of severe types of GERD. Mechanisms in addition to acid reflux must contribute to the development of Barrett's esophagus.
KW - Alcohol consumption
KW - Cigarette smoking
KW - Epidemiology
KW - Esophageal pH-monitoring
KW - Gastroesophageal reflux disease
KW - Hiatus hernia
KW - Intestinal metaplasia
KW - Lower esophageal sphincter pressure
UR - http://www.scopus.com/inward/record.url?scp=0036164094&partnerID=8YFLogxK
U2 - 10.1023/A:1013797417170
DO - 10.1023/A:1013797417170
M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???
C2 - 11855539
AN - SCOPUS:0036164094
SN - 0163-2116
VL - 47
SP - 256
EP - 264
JO - Digestive Diseases and Sciences
JF - Digestive Diseases and Sciences
IS - 2
ER -