Some patients with gastroesophageal reflux disease (GERD) develop Barrett's esophagus, which involves a specialized intestinal metaplasia of the esophageal mucosa and an associated risk for adenocarcinoma. A patient at risk for Barrett's esophagus may benefit from diagnostic procedures with careful followup. The authors are from the University of Southern California, Los Angeles.
Risk factors:
(1) abnormal bile reflux (presence of bilirubin in esophagus based on an light absorbance reading > 0.2 for > 1.7% of the total time)
(2) large hiatal hernia
(3) defective lower esophageal sphincter
(4) male gender
(5) defective distal esophageal contractions
(6) number of reflux episodes lasting more than 5 minutes
(7) GERD symptoms for more than 5 years
|
Risk Factor |
Finding |
Odds Ratio |
95% Confidence Interval |
|
abnormal bile reflux |
|
4.2 |
1.9 – 9.7 |
|
hiatal hernia |
2 – 4 cm |
2.4 |
1.4 – 4.6 |
|
|
> 4 cm |
4.1 |
2.1 – 8.0 |
|
defective lower esophageal sphincter |
|
2.7 |
1.4 – 5.4 |
|
male gender |
|
2.6 |
1.6 – 4.3 |
|
defective distal esophageal contractions |
|
2.2 |
1.4 – 3.5 |
|
reflux episodes lasting more than 5 minutes |
4 – 7 |
2.1 |
1.2 – 3.7 |
|
|
> 7 |
2.2 |
1.1 – 4.6 |
|
GERD symptoms for > 5 years |
|
2.1 |
1.4 – 3.2 |
An additional risk factor for long segment Barrett's disease is:
(8) longest reflux episode
|
Risk Factors for Long Segment Barretts' |
Finding |
Odds Ratio |
95% Confidence Interval |
|
hiatal hernia |
> 4 cm |
17.8 |
4.1 – 76.6 |
|
|
2-4 cm |
8.5 |
2.3 – 31.7 |
|
defective lower esophageal sphincter |
|
16.9 |
1.6 – 181.4 |
|
longest reflux episode |
19.9 – 31.7 minutes |
6.8 |
2.3 – 20.1 |
|
|
> 31.7 minutes |
8.1 |
2.8 – 24.0 |
|
Risk Factor for Short Segment Barrett's |
Odds Ratio |
95% Confidence Interval |
|
abnormal bile reflux |
4.8 |
1.7 – 13.2 |
number of risk factors =
= SUM(risk factors present)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 7
• A patient with 1 or more risk factors should be evaluated for an anti-reflux operation as a means to prevent development of Barrett's esophagus.
Specialty: Gastroenterology
ICD-10: ,
