Barrett's Esophagus in Practice: Gender and Screening Issues

Abstract

Abstract

Background:

Barrett's esophagus (BE) is a recognized risk factor for esophageal adenocarcinoma (EAC), and both conditions are found predominantly in men. We examined the symptomology in newly diagnosed patients with BE in a tertiary care center from 1999 to 2008 with a focus on gender and segment length of BE.

Methods:

A retrospective study of 158 patients with BE was carried out, with 71 patients classified as long-segment (≥3 cm, LSBE), and 87 as short-segment (<3 cm, SSBE).

Results:

77.9% of the patients were male. Men were significantly younger than women at the time of diagnosis (mean 53 vs. 61 years, p=0.003). 12.7% were under age 40 at diagnosis (90% were male). In patients over 40, women reported nocturnal symptoms more often than men; 69.7% versus 45.7%, p=0.016. The principal presenting symptom was heartburn; median [interquartile range] duration (in months) was significantly longer in LSBE patients: 96 [48, 180] versus 60 [28, 108] months in SSBE; p=0.002. Nocturnal heartburn was more common in LSBE than SSBE (66.2% vs. 40.2%; p=0.028), as was dysphagia (26.8% vs. 11.5%; p=0.014), esophageal ulcers (32.4% vs. 1.1%; p<0.001), and esophageal strictures (12.7% vs. 1.1%, p=0.005.

Conclusions:

Screening guidelines for BE focus on white males over age 50 with a history of chronic gastroesophageal reflux disease/heartburn. Future research is warranted to see if screening for BE should be expanded in select male populations under 50 with gastroesophageal reflux disease, who also have other recognized risk factors for the progression of BE to EAC, like smoking and obesity.