Age at Onset of GERD Symptoms Predicts Risk of Barrett's... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

Esophagus

Thrift, Aaron P PhD1, 2; Kramer, Jennifer R PhD3, 4; Qureshi, Zeeshan MD5; Richardson, Peter A PhD3, 4, 5; El-Serag, Hashem B MD, MPH3, 4, 5

1 Population Health Department, Queensland Institute of Medical Research, Brisbane, Queensland, Australia

2 School of Population Health, University of Queensland, Brisbane, Queensland, Australia

3 Houston VA HSR&D Center of Excellence, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA

4 Section of Heath Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA

5 Section of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA

Correspondence: Dr Hashem B. El-Serag, Houston VA HSR&D Center of Excellence, Health Services Research and Development Service, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard 152, Houston, Texas 77030, USA. E-mail: [email protected]

SUPPLEMENTARY MATERIAL accompanies this paper at https://links.lww.com/AJG/A736, https://links.lww.com/AJG/A737

Received 24 July 2012; accepted 11 December 2012

published online 9 April 2013

Abstract

OBJECTIVES:

Symptoms of gastroesophageal reflux disease (GERD) are the primary risk factor for Barrett's esophagus (BE). However, the significance of age at symptom onset is unknown. We examined the effects of multiple dimensions of GERD exposure on BE risk and whether these associations are modified by other risk factors for BE.

METHODS:

Data were from a cross-sectional study of 683 Veterans Affairs patients undergoing an elective esophagogastroduodenoscopy (EGD) or a study EGD concurrently with colonoscopy from primary care clinics. We compared 236 patients with both endoscopically suspected and histologically confirmed BE to 447 primary-care patients (“primary-care controls”) without endoscopically suspected BE on their study EGD. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariate logistic regression.

RESULTS:

Age at onset <30 years of frequent (at least weekly) GERD symptoms was associated with highest risk of BE (OR=15.1, 95% CI 7.91–28.8), and risk increased linearly with earlier age at onset of symptoms ( P -trend=0.001). This association was independent of cumulative GERD symptom duration. People with early onset GERD symptoms who reported ever using proton pump inhibitors were at especially high risk of BE (OR=31.1, 95% CI 13.9–69.7). In people with frequent GERD symptoms, BE risk was almost 80% lower among Helicobacter pylori -positive patients (OR=2.60, 95% CI 1.26–5.40) than those negative for H. pylori (OR=8.24, 95% CI 5.00–13.6).

CONCLUSIONS:

Risk of BE increased linearly with earlier age at onset of frequent GERD symptoms. Age at symptom onset may help practitioners decide which patients with GERD symptoms to refer for endoscopic screening for BE.