Epidemiology and Risk Factors for Barrett’s Esophagus and Esophageal Adenocarcinoma  Amitabh Chak, MD University Hospitals...
Pohl, H. et al. J Natl Cancer Inst 2005;97:142-146 EAC melanoma prostate breast/lung colon
Bytzer et al. AJG  1999
 
 
Progression  (histology, courtesy of JHU website) BE LGD HGD CA (1.5 – 4 yrs) (0.5 – 1.5 yrs)
Prevalence of BE
Risk Factors for BE/EAC <ul><li>UNALTERABLE RISKS </li></ul><ul><li>Age </li></ul><ul><li>Gender </li></ul><ul><li>Race </...
Age of Cancer Diagnosis Chak et al., AJG 2009  -  MEAN AGE = 62 years
Age Prevalence of BE  (Cameron, et al.)
Men:Women Ratio in EAC and BE Country (N) Disease M:W Gammon et al., JNCI, 1992 USA 293 EAC 5:1 Byzer et al., AJG 1999 Den...
Race Predominance <ul><li>Primarily Caucasian diseases - Majority of studies report > 90% of BE and EAC patients are Cauca...
Chronic GERD  and EAC (Lagergren, et al. NEJM 1999) Multivariate adjustment for age. Sex, BMI, smoking, etc.
Frequency, Severity, and Duration
GERD and BE (Conio M, et al., Int J Cancer 2002) Eight Centers from Italy. Case control study .  Odds Ratios Adjusted for ...
GERD Symptoms and BE (Eisen et al., AJG 1997) Case Control Study of 79 pts with BE and 180 controls
Symptom Duration and BE P < 0.05 for difference in duration and difference in age  Of onset of symptoms
Symptom Duration and BE (Lieberman et al., AJG 1997) GORGE Dtaabase of endoscopic procedures in Portland, OR
Obesity Increases Risk of GERD (Corley et al. 2007)
Lagergren et al. 1999 (Association of Obesity is Independent of GERD) ODDS  RATIO Body Mass Index
Meta-Analysis of Obesity and EAC (Corley et al., CEBP 2006) Excluded the Lagergren study because of heterogeneity
AGE IN YEARS OBESE NON-OBESE
Association of BE with Abdominal Obesity (Corley et al., Gastro 2007) 320 BE Cases and 317 Population Controls OR = 2.24 (...
Association of BE with Abdominal Obesity (Vaughan et al., Gastro 2007) 193 community cases and 211 matched population cont...
Association of High WHR Independent of GERD (Vaughan et al.)
Smoking/EtOH and EAC (Brown et al., Cancer Causes Ctl, 1994)
Smoking/EtOH and EAC (Gammon et al., JNCI 1997)
Smoking/EtOH and BE (Conio et al.)
ASA/NSAIDs and EAC (Corley et al., Gastro 2003)
LES Lowering Meds and EAC (Lagergren, et al. AIM 2000)
H. Pylori and BE/EAC (Weston et al., AJG 2000)
Strain Specific H. pylori (Vaezi et al., AJG 2000)
Implications of Epidemiological Associations <ul><li>Selection of screening population </li></ul><ul><ul><li>Consider scre...
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Endoscopy in Gastrointestinal Oncology - Slide 1 - A. Chak - Risk factors for Barrett's esophagus

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Endoscopy in Gastrointestinal Oncology - Slide 1 - A. Chak - Risk factors for Barrett's esophagus

  1. 1. Epidemiology and Risk Factors for Barrett’s Esophagus and Esophageal Adenocarcinoma Amitabh Chak, MD University Hospitals Case Medical Center Cleveland, OH
  2. 2. Pohl, H. et al. J Natl Cancer Inst 2005;97:142-146 EAC melanoma prostate breast/lung colon
  3. 3. Bytzer et al. AJG 1999
  4. 6. Progression (histology, courtesy of JHU website) BE LGD HGD CA (1.5 – 4 yrs) (0.5 – 1.5 yrs)
  5. 7. Prevalence of BE
  6. 8. Risk Factors for BE/EAC <ul><li>UNALTERABLE RISKS </li></ul><ul><li>Age </li></ul><ul><li>Gender </li></ul><ul><li>Race </li></ul><ul><li>Family History </li></ul><ul><li>ALTERABLE RISKS </li></ul><ul><li>GERD </li></ul><ul><li>Obesity (Diet) </li></ul><ul><li>Smoking/Alcohol </li></ul><ul><li>H. Pylori </li></ul><ul><li>Medications </li></ul>
  7. 9. Age of Cancer Diagnosis Chak et al., AJG 2009 - MEAN AGE = 62 years
  8. 10. Age Prevalence of BE (Cameron, et al.)
  9. 11. Men:Women Ratio in EAC and BE Country (N) Disease M:W Gammon et al., JNCI, 1992 USA 293 EAC 5:1 Byzer et al., AJG 1999 Denmark 524 EAC 4:1 Lagergren, et al. NEJM 1999 Sweden 189 EAC 6.7:1 Caygill et al., AJG 2002 UK 507 BE 1.7:1 Conio et al., IJC, 2002 Italy 149 BE 3:1 Rex, et al., Gastro 2003 USA 65 BE 2.6:1
  10. 12. Race Predominance <ul><li>Primarily Caucasian diseases - Majority of studies report > 90% of BE and EAC patients are Caucasians </li></ul><ul><li>Younes et al. reported an increase of BE in Hispanics in US </li></ul><ul><li>Although there are reports of increasing BE and EAC in Japan it is very small compared to US/Europe/Australia </li></ul><ul><li>Unclear whether race predominance represents a genetic or environmental factor </li></ul>
  11. 13. Chronic GERD and EAC (Lagergren, et al. NEJM 1999) Multivariate adjustment for age. Sex, BMI, smoking, etc.
  12. 14. Frequency, Severity, and Duration
  13. 15. GERD and BE (Conio M, et al., Int J Cancer 2002) Eight Centers from Italy. Case control study . Odds Ratios Adjusted for Age, gender, and center
  14. 16. GERD Symptoms and BE (Eisen et al., AJG 1997) Case Control Study of 79 pts with BE and 180 controls
  15. 17. Symptom Duration and BE P < 0.05 for difference in duration and difference in age Of onset of symptoms
  16. 18. Symptom Duration and BE (Lieberman et al., AJG 1997) GORGE Dtaabase of endoscopic procedures in Portland, OR
  17. 19. Obesity Increases Risk of GERD (Corley et al. 2007)
  18. 20. Lagergren et al. 1999 (Association of Obesity is Independent of GERD) ODDS RATIO Body Mass Index
  19. 21. Meta-Analysis of Obesity and EAC (Corley et al., CEBP 2006) Excluded the Lagergren study because of heterogeneity
  20. 22. AGE IN YEARS OBESE NON-OBESE
  21. 23. Association of BE with Abdominal Obesity (Corley et al., Gastro 2007) 320 BE Cases and 317 Population Controls OR = 2.24 (1.21-4.15) for Waist > 80 vs. waist < 80, p = 0.08 for trend
  22. 24. Association of BE with Abdominal Obesity (Vaughan et al., Gastro 2007) 193 community cases and 211 matched population controls Odds ratios of BMI and WHR adjusted for each other in LSBE patients
  23. 25. Association of High WHR Independent of GERD (Vaughan et al.)
  24. 26. Smoking/EtOH and EAC (Brown et al., Cancer Causes Ctl, 1994)
  25. 27. Smoking/EtOH and EAC (Gammon et al., JNCI 1997)
  26. 28. Smoking/EtOH and BE (Conio et al.)
  27. 29. ASA/NSAIDs and EAC (Corley et al., Gastro 2003)
  28. 30. LES Lowering Meds and EAC (Lagergren, et al. AIM 2000)
  29. 31. H. Pylori and BE/EAC (Weston et al., AJG 2000)
  30. 32. Strain Specific H. pylori (Vaezi et al., AJG 2000)
  31. 33. Implications of Epidemiological Associations <ul><li>Selection of screening population </li></ul><ul><ul><li>Consider screening of white men > 50 with GERD symptoms of greater than 5 years </li></ul></ul><ul><li>Possible explanations for rising incidence of EAC </li></ul><ul><ul><li>obesity, meds that lower LES, eradication of H. pylori </li></ul></ul><ul><li>Interventions for patients with BE </li></ul><ul><ul><li>Weight loss, smoking cessation, GERD therapy </li></ul></ul>

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