Predictive factors of Barrett esophagus - Multivariate analysis of 502 patients with gastroesophageal reflux disease

Hypothesis: Risk factors for the presence and extent of Barrett esophagus ( BE) can be identified in patients with gastroesophageal reflux disease (GER D). Design: Case-comparison study. Setting: University tertiary referral center. Patients: Five hundred two consecutive patients with GERD documented by 24- hour esophageal pH monitoring and with complete demographic. endoscopic, an d physiological evaluation. divided in groups according to the presence and extent of BE (328 patients without BE and 174 with BE [67 short-segment BE and 107 long-segment BE]). Main Outcome Measures: Clinical, endoscopic, and physiological data, studie d by multivariate analysis, to identify the independent predictors of the p resence and extent of BE. Results: Seven factors were identified as predictors of BE. They were abnor mal bile reflux (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.9-9. 7), hiatal hernia larger than 4 cm (OR, 4.1; 95% Cl, 2.1-8.0). a defective lower esophageal sphincter (OR. 2.7; 95% CI, 1.4-5.4). male sex (OR, 2.6; 9 5% Cl, 1.6-4.3). defective distal esophageal contraction (OR, 2.2; 95% CI, 1.4-3.5), abnormal number of reflux episodes lasting longer than 5 minutes (OR, 2.2; 95% CI. 1.1-4.6), and GERD symptoms lasting for more than 5 years (OR, 2.1 95% CL 1.4-3.2). Only abnormal bile reflux (OR. 4.8; 95% CI, 1.7- 13.2) was identified as a predictor of short-segment BE (baseline, no BE). Three factors were identified as predictors of long-segment BE (baseline sh ort-segment BE). They were hiatal hernia larger than 4 cin (OR, 17.8; 95% C I, 4.1-76.6), a defective lower esophageal sphincter (OR, 16.9 95% CI, 1.6- 181.4), and an abnormal longest reflux episode (OR, 8.1 95% CI, 2.8-24.0).