Risk Factors for Barrett's Esophagus Among Patients With Gastroesophageal Reflux Disease: A Community Clinic-Based Case-Control Study

OBJECTIVES: Our aim was to measure the relative risks of Barrett's esophagus (BE) associated with demographic factors, measures of adiposity, and smoking among patients with gastroesophageal reflux disease (GERD). METHODS: Patients newly diagnosed with specialized intestinal metaplasia (SIM) (n = 197) were compared with patients with GERD (n = 418) in a community clinic-based case-control study. Case subgroups included those with any visible columnar epithelium (VBE) (n = 97), and those with a long segment (= 2 cm) of columnar epithelium (LSBE) (n = 54). RESULTS: Risks increased with older age (adjusted odds ratio (aOR) per decade for SIM = 1.3, 95% confidence interval (CI) = 1.1-1.5; VBE aOR = 1.4, CI = 1.1-1.6; LSBE aOR = 1.5, CI = 1.2-1.9), male gender (SIM aOR = 1.5, CI = 1.1-2.2; VBE aOR = 2.7, CI = 1.6-4.5; LSBE aOR = 3.9, CI = 1.9-8.1), and possibly Asian race. Increased risk of BE was observed with high waist-to-hip ratio (WHR, male high: = 0.9, female high: = 0.8) (SIM aOR = 1.3, CI = 0.9-2.1; VBE aOR = 1.9, CI = 1.0-3.5; LSBE aOR = 4.1, CI = 1.5-11.4). These associations were independent of body mass index (BMI) for the VBE and LSBE case groups but not for SIM, which was the only case group in which BMI was a significant risk factor. Ever having smoked cigarettes increased risk similarly for all case groups (SIM aOR = 1.8, CI = 1.2-2.6; VBE aOR = 1.6, CI = 1.0-2.6; LSBE aOR = 2.6, CI = 1.3-4.9), although a dose-response relationship was not detected for duration or intensity of smoking. CONCLUSIONS: Older age, male gender, and history of smoking increased risk of SIM and BE among GERD patients independent of other risk factors for BE. Central adiposity was most strongly related to risk of VBE and LSBE. These results may be useful in the development of risk profiles for screening GERD patients.