Clinical Research
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2005; 11(43): 6807-6814
Published online Nov 21, 2005. doi: 10.3748/wjg.v11.i43.6807
Characteristics of patients with columnar-lined Barrett’s esophagus and risk factors for progression to esophageal adenocarcinoma
Kamal E Bani-Hani, Bayan K Bani-Hani, Iain G Martin
Kamal E Bani-Hani, Bayan K Bani-Hani, Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
Iain G Martin, Academic Surgical Unit and Center for Digestive Diseases, The General Infirmary, Leeds LS1 3EX, United Kindom
Author contributions: All authors contributed equally to the work.
Correspondence to: Kamal E Bani-Hani, Professor of Surgery, Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, PO Box 3030, Jordan.
Telephone: +962-2-7060200 Fax: +962-2-7095010
Received: March 26, 2005
Revised: April 26, 2005
Accepted: April 30, 2005
Published online: November 21, 2005

AIM: To determine the risk factors for the development of esophageal adenocarcinoma in these patients with columnar-lined esophagus (CLE).

METHODS: Data collected retrospectively on 597 consecutive patients diagnosed at endoscopy and histology to have CLE at Leeds General Infirmary between 1984 and 1995 were analyzed. Factors evaluated included age, sex, length of columnar segment, smoking, and drinking habits, history of non-steroidal ingestion, presence of endoscopic esophagitis, ulceration or benign strictures and presence of Helicobacter pylori in esophageal biopsies. Univariate and multivariate analyses were performed to identify risk factors for the development of adenocarcinoma.

RESULTS: Forty-four patients presented or developed esophageal adenocarcinoma during follow-up. Independent risk factors for the development of adenocarcinoma in patients with CLE were males (OR 5.12, 95%CI 2.04-12.84, P = 0.0005), and benign esophageal stricture (OR 4.37, 95%CI 2.02-9.45, P = 0.0002). Male subjects and patients who developed benign esophageal stricture constituted 86% (n = 38) of all patients who presented or developed esophageal adenocarcinoma. The presence of esophagitis was associated with a significant reduction in the development of esophageal carcinoma (OR 0.28, 95%CI 0.13-0.57, P = 0.0006). No other clinical characteristics differentiate between the non-malignant and malignant group.

CONCLUSION: In patients with CLE, endoscopic surveillance for the early detection of adenocarcinoma may be restricted to male subjects, as well as patients who develop benign esophageal strictures.

Keywords: Barrett's esophagus, Adenocarcinoma, Risk factors, Esophageal adenocarcinoma, Esophageal stricture