Prediction of Barrett's esophagus among men

Abstract

Objectives: Risk factors for Barrett's esophagus include gastroesophageal reflux disease (GERD) symptoms, age, abdominal obesity, and tobacco use. We aimed to develop a tool using these factors to predict the presence of Barrett's esophagus.

Methods: Male colorectal cancer (CRC) screenees were recruited to undergo upper endoscopy, identifying newly diagnosed cases of Barrett's esophagus. Logistic regression models predicting Barrett's esophagus using GERD symptoms alone and together with abdominal obesity, tobacco use, and age were compared.

Results: Barrett's esophagus was found in 70 (8.5%) of 822 CRC screenees. Mutually adjusting for other covariates, Barrett's esophagus was associated with weekly GERD (odds ratio (OR)=2.33, 95% confidence interval (CI)=1.34, 4.05), age (OR per 10 years=1.53, 95% CI=1.05, 2.25), waist-to-hip ratio (OR per 0.10=1.44, 95% CI=0.898, 2.32) and pack-years of cigarette use (OR per 10 pack-years=1.09, 95% CI=1.04, 1.14). A model including those four factors had a greater area under the receiver operating characteristics curve than did a model based on GERD frequency and duration alone (0.72 vs. 0.61, P<0.001), and it had a net reclassification improvement index of 19-25%.

Conclusions: The prevalence of Barrett's esophagus was substantial in our population of older overweight men. A model based on GERD, age, abdominal obesity, and cigarette use more accurately classified the presence of Barrett's esophagus than did a model based on GERD alone. Following validation of the tool in another population, its use in clinical practice might improve the efficiency of screening for Barrett's esophagus.

Conflict of interest statement

CONFLICT OF INTEREST

Guarantor of the article: Joel H. Rubenstein, MD, MSc.

Specific author contributions: Conceived and designed the study, acquired data, analyzed and interpreted the data, drafted the manuscript, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis: JHR; designed the study, supervised the statistical analysis, interpreted the data, and critically revised the manuscript: HM; acquired data, interpreted the data, and critically revised the manuscript: HA, JS and PS; interpreted the data, and critically revised the manuscript: LM; acquired data, and critically revised the manuscript: VM, EN, TK and JK; designed the study, interpreted the data, and critically revised the manuscript: JMI.

Financial support: Research and salary funding was provided by the National Institutes of Health (JHR: K23DK079291, JMI: K24DK080941, PS: K24DK084208), the Damon Runyon Cancer Research Foundation Gordon Family Clinical Investigator Award (JHR: CI 36-07), and an American Society for Gastrointestinal Endoscopy Senior Mentoring Investigator Award (JS), none of which had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript.

Potential competing interest: JHR has received grant support and served as a consultant to Xenoport. JS has served as a consultant to AstraZeneca, Pfizer, Novartis, Pozen, and Stryker. JMI has served as a consultant to Takeda, AstraZeneca, and Roche. These potential conflicts of interest were not disclosed to study participants. HA, HM, VM, EN, TK, JK, and PS have no potential conflicts of interest.

Figures

Figure 1

Flow diagram of recruitment and classification of subjects. Gastroesophageal reflux disease (GERD) is defined as symptoms of heartburn or regurgitation at least once a week while not taking acid-reducing medications. Sixteen colorectal cancer (CRC) screenees had missing GERD status, none of whom had Barrett’s esophagus. There was also 1 CRC screenee without GERD and with suspected Barrett’s esophagus, but biopsies were not obtained due to coexisting esophageal varices. That subject was unclassified regarding Barrett’s esophagus status, and not included in further analyses. BE, Barrett’s esophagus; EGD, esophagogastroduodenoscopy.

Figure 2

Receiver operating characteristic (ROC) curves for Michigan Barrett’s Esophagus pREdiction Tool (M-BERET) and gastroesophageal reflux disease (GERD) Models of Barrett’s esophagus risk among colorectal cancer screenees. The GERD model includes frequency and duration of symptoms. The M-BERET model includes GERD frequency, age, waist-to-hip ratio, and pack-years of cigarette use.