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Prediction of Barrett's Esophagus Among Men

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  • Prediction of Barrett's Esophagus Among Men

    Prediction of Barrett's Esophagus Among Men

    Joel H. Rubenstein, MD, MSc, Hal Morgenstern, PhD, Henry Appelman, MD, James Scheiman, MD, Philip Schoenfeld, MD, MS, Laurence F. McMahon Jr, MD, Valbona Metko, MD, Ellen Near, BA, Joan Kellenberg, MS, MPH, Tal Kalish, MSc, John M. Inadomi, MD

    Am J Gastroenterol. 2013;108(3):353-362.


    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.