RISK-FACTORS FOR THE DEVELOPMENT OF AN ADENOCARCINOMA IN COLUMNAR-LINED (BARRETT) ESOPHAGUS

Background. To evaluate the importance of the length of columnar-lined esophagus, sex, age, smoking, and drinking habits as risk factors for malignant degeneration, the authors performed a retrospective case-co ntrol study comparing patients with and without adenocarcinoma in Barr ett esophagus. Methods. The records of 96 patients (53 male and 43 fem ale; mean age, 61 years) with a benign columnar-lined esophagus and 62 patients (47 male and 15 female; mean age, 62 years) with an adenocar cinoma in columnar-lined esophagus referred to the Rotterdam Esophagea l Tumor Study Group, diagnosed over the same period (1978-1985), were reviewed. A frequency distribution of the length of columnar-lined eso phagus in both groups was made. Statistical analysis was performed wit h multivariate methods. Results. The length of columnar-lined esophagu s was related significantly to carcinoma: a doubling of the length res ulted in a 1.7 times increased risk. Smokers had a 2.3-fold increased risk as compared with nonsmokers. Male sex as a risk factor approached statistical significance (P = 0.06). Adjusted for these risk factors, no relation between carcinoma and age or alcohol consumption was foun d. Conclusions. The risk of development of an adenocarcinoma in Barret t esophagus increased with the length of Barrett epithelium. Smoking a nd possibly male sex were also risk factors. The identification of the se risk factors may help in developing more efficient screening progra ms for patients with Barrett esophagus.