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Revista de la Facultad de Medicina Humana
versión impresa ISSN 1814-5469versión On-line ISSN 2308-0531
Rev. Fac. Med. Hum. vol.21 no.1 Lima ene-mar 2021
http://dx.doi.org/10.25176/rfmh.v21i1.3119
Review article
Risk factors associated with Barrett's Esophagus in hospitalized patients
1Instituto de Investigación en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú.
Objective:
The objective of this article is to carry out a systematic review of scientific articles that reveal the risk factors associated with Barret's esophagus in hospitalized patients.
Methods:
The review was performed by electronic search for articles related to risk factors associated with Barret's esophagus in hospitalized patients. The PEO question was: What are the risk factors associated with Barret's esophagus in hospitalized patients? The search sources were in PUBMED. The search terms were: Risk Factors; Barret's esophagus; hospitalized patients. For this review, articles published from 2010 that had research experiences and theoretical-conceptual aspects were selected.
Results:
Of the 389 results found with indexing sources, a total of 25 articles were selected where 22 articles contained research results and 3 were considered for theoretical-conceptual aspects that are related to the purpose of the study. The search resulted in risk factors associated with Barret's esophagus according to demographic characteristics and patient traits, presentation, and clinical data and lifestyles.
Conclusion:
An association of various risk factors with Barret's esophagus is evidenced in hospitalized patients. The most concordant risk factors associated with Barret's esophagus in the review were male sex, increased age, metabolic syndrome, hiatal hernia, use of proton pump inhibitors, gastroesophageal reflux (GER), obstructive sleep apnea, and erosive esophagitis.
Key words: Risk Factors; Barret's Esophagus; Patients. (Source: MeSH NLM)
INTRODUCTION
At present, there are several risk factors for Barrett's esophagus which have not been fully reviewed in hospitalized patients. Barrett's esophagus is an acquired esophageal condition characterized by the presence of metaplastic columnar epithelium in the distal esophagus that replaces the normal stratified squamous mucosa. Factors associated with Barrett's esophagus are symptoms of gastroesophageal reflux disease (GERD), advanced age, and male gender. Studies have revealed an association with central obesity (waist / hip ratio or abdominal circumference, but less clearly with body mass index or overall body fat content), smoking, Caucasian race, and a positive family history. In contrast, alcohol consumption does not appear to be a significant risk factor. Research has also found possible risk factors, such as metabolic syndrome, type 2 diabetes mellitus, and sleep apnea.1
A potential mechanism of BE pathogenesis involves transdifferentiation, in which fully differentiated esophageal squamous cells change to fully differentiated columnar cells, either directly (without undergoing cell division) or indirectly (through cell division). Although once differentiated cells are considered immutable, studies have shown that differentiated cells can be reprogrammed to acquire characteristics of immature progenitor cells. Many types of mature cells have the ability to de-differentiate into cells with progenitor cell characteristics. Therefore, trans difference in the esophagus can occur through a 2-stage GERD process in an induced reprogramming in which mature squamous cells reverse their differentiation to acquire progenitor cell plasticity before changing to a columnar phenotype.2
The diagnosis of Barrett's esophagus should appear to be straightforward, that means, a visible change in the lining of the distal esophagus and histologic confirmation with columnar metaplasia. Diagnostic components of Barrett's esophagus include endoscopic recognition, appropriately targeted biopsies, and histologic confirmation.3
The objective of this article is to carry out a systematic review of scientific articles which reveal the risk factors associated with Barrett's esophagus in hospitalized patients.
METHODS
A systematic search of electronic databases was carried out to identify publications related to risk factors for Barret's esophagus, in the PUBMED indexing source. The PEO question was: What are the risk factors associated with Barret's esophagus in hospitalized patients?
The advanced search terms for PUBMED were: Risk factors, Barret's esophagus and patients. For this review, articles published with research results and those with theoretical-conceptual aspects since June 2010 and carried out in humans were selected with the help of the PUBMED advanced search. The systematic search used in PUBMED was: ((Patients(tiab) OR patient(tiab) OR Clients(tiab) OR Client(tiab)) AND (risk factors(tiab) OR Factor, Risk(tiab) OR Factors, Risk(tiab) OR Risk Factor(tiab) OR Population at Risk(tiab) OR Risk, Population at(tiab) OR Populations at Risk(tiab) OR Risk, Populations at(tiab) AND (Barrett Metaplasia(tiab) OR Barrett Metaplasias(tiab) OR Metaplasia, Barrett(tiab) OR Metaplasias, Barrett(tiab) OR Barrett's Syndrome(tiab) OR barrett Syndrome(tiab) OR Barrett Syndrome(tiab) OR Barrett's Esophagus(tiab) OR barrett Esophagus(tiab) OR Esophagus, Barrett's(tiab) OR Esophagus, Barrett(tiab) OR Barrett Epithelium(tiab) OR Epithelium, Barrett)).Figure 1shows the process of selecting the terms for the systematic search.
DeCS | MeSH | MeSH + Entry terms | ||
P | Participants | Pacients | “patient” (Mesh) | Patiens(tiab) OR patient(tiab) OR Clients(tiab) OR Client(tiab) |
E | Exposition | Risk factor | “risk factors” (Mesh) | Risk factors(tiab) OR Factor, Risk(tiab) OR Factors, Risk(tiab) OR Risk Factor(tiab) OR Population at Risk(tiab) Pr Risk, Population at(tiab) Or Populations at Risk(tiab) OR Risk, Populations at(tiab) |
O | Outcome | Barrett's esophagus | “Barrett Esophagus” (Mesh) | (Barrett Metaplasia(tiab) OR Barrett Metaplasias(tiab) OR Metaplasia, Barrett(tiab) OR Metaplasias, Barrett(tiab) OR Barrett’s Syndrome(tiab) OR barrett Syndrome(tiab) OR Barrett Syndrome(tiab) OR Barrett’s Esophagus(tiab) OR barrett Esophagus(tiab) OR Esophagus, Barrett’s(tiab) OR Esophagus, Barrett(tiab) OR Esophagus, Barrett(tiab) OR Barrett Epithelium(tiab) OR Epithelium, Barrett)) |
The exclusion criteria were articles not in accordance with the subject of the review and without association measure values (RR, OR, HR).
RESULTS
A total of 389 results were obtained in the systematic search found in PUBMED and a total of 25 articles were selected where 22 articles contained research results and 3 were considered for theoretical-conceptual aspects that are related to the purpose of the study. Figure 2 shows the article selection process in PUBMED.
The search resulted in risk factors associated with Barret's esophagus according to demographic characteristics and patient traits, presentation and clinical data, and lifestyles. Table 2, muestra los factores de riesgo para Esófago de Barret en pacientes hospitalizados de estudios observacionales de cohorte y casos y controles seleccionados para el artículo de revisión.
MEASURED RISK FACTOR | AUTHOR | STUDY TYPE | ARTICLE | POPULATION | MEASUREMENT VALUE | CI 95% | P |
---|---|---|---|---|---|---|---|
Demographic characteristics and patient traits (Age, Sex, ethnicity, BMI) | |||||||
Male patient | Yousaf Bashir Hadi4 | cases and controls | Independent association of obstructive sleep apnea with Barrett’s esophagus | 1091 | OR:1.71 | 1.13-2.59 | <0.01 |
Male patient | Emery C Lin5 | Cohort study | Low Prevalence of Suspected Barrett’s Esophagus in Gastroesophageal Reflux Disease Without Alarm Symptoms | 4122 | OR:2.61 | 2.44 - 2.79 | |
Male patient | Yan-Hua Chen6 | Cohort study | Prevalence and risk factors for Barrett’s esophagus in Taiwan | 3385 | OR:2.106 | 1.145-3.872 | 0.017 |
Male patient | A. Sonnenberg7 | cases and control | The influence of Helicobacter pylori on the ethnic distribution of Barrett’s metaplasia | 596 479 | OR: 3.34 | 3.28-3.40 | <0.0001 |
Male patient | Theresa H. Nguyen8 | cases and control | Risk Factors for Barrett’s Esophagus Compared Between African Americans and Non-Hispanic Whites | 1952 | OR:3.35 | 1.51-7.43 | 0.003 |
Male patient | K. Keyashian9 | cases and control | Barrett’s esophagus in Latinos undergoing endoscopy for gastresophageal reflux disease symptoms | 663 | OR:2.34 | 1.35-4.05 | 0.002 |
Female patient | Matheus Degiovani10 | cases and control | Is there a relation between helybacter pylori and intestinal metaplasia in short column epitelization up to 10 mm in the distal esophagus? | 373 | OR:1.76 | 1.13 - 2.76 | 0.013 |
increased age | Yousaf Bashir Hadi4 | cases and control | Independent association of obstructive sleep apnea with Barrett’s esophagus | 1091 | OR:1.04 | 1.02-1.06 | <0.01 |
increased age | Atsuhiro Masuda11 | Cohort study | Influence of hiatal hernia and male sex on the relationship between alcohol intake and occurrence of Barrett’s esophagus | 8031 | OR:1.42 | 1.23-1.64 | <0.0001 |
increased age | Matheus Degiovani10 | cases and control | IS THERE A RELATION BETWEEN HELYBACTER PYLORI AND INTESTINAL METAPLASIA IN SHORT COLUMN EPITELIZATION UP TO 10 MM IN THE DISTAL ESOPHAGUS? | 373 | OR:1.017 | 1.001 -1.033 | 0.031 |
increased age | Yan-Hua Chen6 | Cohort study | Prevalence and risk factors for Barrett’s esophagus in Taiwan | 3385 | OR:1.033 | 1.012-1.055 | 0.002 |
increased age | Rena Yadlapati12 | Cohort study | Reduced Esophageal Contractility Is Associated with Dysplasia Progression in Barrett’s Esophagus: A Multicenter Cohort Study | 193 | OR:1.08 | 1.01-1.16 | 0.03 |
increased age | Wytske M. Westra13 | Cases and controls (Cigarette and smokeless tobacco users vs Non-users) | Smokeless Tobacco and Cigar and/or Pipe Are Risk Factors for Barrett Esophagus in Male Patients With Gastroesophageal Reflux Disease | 1015 | OR:1.06 | 1.05-1.08 | <.001 |
increased age | Wytske M. Westra13 | Cases and controls (cigarette and cigar users vs Non-users) | Smokeless Tobacco and Cigar and/or Pipe Are Risk Factors for Barrett Esophagus in Male Patients With Gastroesophageal Reflux Disease | 1015 | OR:1.06 | 1.05-1.08 | <.001 |
increased age | A. Sonnenberg7 | cases and control | The influence of Helicobacter pylori on the ethnic distribution of Barrett’s metaplasia | 596 479 | OR: 18.29 | 17.39-19.24 | <0.0001 |
increased age | K. Keyashian9 | cases and control | Barrett’s esophagus in Latinos undergoing endoscopy for gastresophageal reflux disease symptoms | 663 | OR:2.17 | 1.25-3.76 | 0.006 |
increased age | Gloria Vargas Cárdenas14 | cases and control | Esófago de Barrett: Prevalencia y Factores de Riesgo en el Hospital Nacional “Arzobispo Loayza” Lima-Perú | 11,970 | OR: 2.57 | 1.41-4.69 | 0.001 |
age 40 to 49 years | Emery C Lin5 | Cohort study | Low Prevalence of Suspected Barrett’s Esophagus in Gastroesophageal Reflux Disease Without Alarm Symptoms | 4122 | OR:1.32 | 1.18 - 1.47 | |
age 50 to 59 years | Emery C Lin5 | Cohort study | Low Prevalence of Suspected Barrett’s Esophagus in Gastroesophageal Reflux Disease Without Alarm Symptoms | 4122 | OR:1.54 | 1.39 - 1.71 | |
age 60 to 69 years | Emery C Lin5 | Cohort study | Low Prevalence of Suspected Barrett’s Esophagus in Gastroesophageal Reflux Disease Without Alarm Symptoms | 4122 | OR:1.68 | 1.51 - 1.87 | |
equal to or greater than 70 years | Emery C Lin5 | Cohort study | Low Prevalence of Suspected Barrett’s Esophagus in Gastroesophageal Reflux Disease Without Alarm Symptoms | 4122 | OR:1.42 | 1.25 - 1.61 | |
BMI greater than 25 | Hirohiko Shinkai15 | cases and controls | Association between the Body Mass Index and the Risk of Barrett’s Esophagus in Japan | 113 | OR: 3.45 | 1.30-9.13 | <0.01 |
North european | A. Sonnenberg7 | cases and control | The influence of Helicobacter pylori on the ethnic distribution of Barrett’s metaplasia | 596 479 | OR: 1.14 | 1.03-1.26 | 0.0117 |
Presentation and clinical data (medical history) | |||||||
Metabolic syndrome | Shou-Wu Lee16 | cases and controls | Association of metabolic syndrome with erosive esophagitis and Barrett’s esophagus in a Chinese population | 7712 | OR:2.82 | 2.05-3.88 | <0.001 |
Metabolic syndrome | Cadman L. Leggett17 | cases and controls BE VS with GERD | Metabolic Syndrome as a Risk Factor for Barrett Esophagus: A Population-Based Case-Control Study | 309 | OR:2 | 1.1-3.6 | 0.02 |
Metabolic syndrome | Cadman L. Leggett17 | cases and controls BE vs without GERD | Metabolic Syndrome as a Risk Factor for Barrett Esophagus: A Population-Based Case-Control Study | 309 | OR:1.9 | 1.03-3.6 | 0.04 |
central obesity | Chih-Cheng Chen18 | cases and controls | Central Obesity and H. pylori Infection Influence Risk of Barrett’s Esophagus in an Asian Population | 161 | OR:2.79 | 1.89-4.12 | <0.001 |
Diabetes | K. Keyashian9 | cases and controls | Barrett’s esophagus in Latinos undergoing endoscopy for gastresophageal reflux disease symptoms | 663 | OR:2.23 | 1.10-4.53 | 0.03 |
hiatal hernia | Camille Bazin19 | cases and controls | Esophageal Motor Disorders Are a Strong and Independant Associated Factor of Barrett’s Esophagus | 201 | OR:5.60 | 2.45-12.76 | < 0.001 |
hiatal hernia | Atsuhiro Masuda11 | Cohort study | Influence of hiatal hernia and male sex on the relationship between alcohol intake and occurrence of Barrett’s esophagus | 8031 | OR:3.37 | 2.50-4.59 | <0.0001 |
hiatal hernia | Emery C Lin5 | Cohort study | Low Prevalence of Suspected Barrett’s Esophagus in Gastroesophageal Reflux Disease Without Alarm Symptoms | 4122 | OR:1.60 | 1.50 - 1.70 | |
hiatal hernia | Yan-Hua Chen6 | Cohort study? | Prevalence and risk factors for Barrett’s esophagus in Taiwan | 3385 | OR:3.037 | 1.765-5.225 | < 0.001 |
hiatal hernia | Praveen Mathew20 | cases and controls | Risk factors for Barrett’s esophagus in Indian patients with gastroesophageal reflux disease | 278 | OR:3.14 | 1.2-8.17 | 0.01 |
hiatal hernia less than 3cm | Theresa H. Nguyen8 | cases and controls | Risk Factors for Barrett’s Esophagus Compared Between African Americans and Non-Hispanic Whites | 1952 | OR:2.79 | 1.85-4.19 | <0.001 |
hiatal hernia greater than or equal to 3cm | Theresa H. Nguyen8 | cases and controls | Risk Factors for Barrett’s Esophagus Compared Between African Americans and Non-Hispanic Whites | 1952 | OR:5.08 | 3.35-7.69 | <0.001 |
Hiatal hernia | Hirohiko Shinkai15 | cases and controls | Association between the Body Mass Index and the Risk of Barrett’s Esophagus in Japan | 113 | OR:18.3 | 7.21-46.5 | <0.01 |
Active gatritis (antrum) | Theresa H. Nguyen8 | cases and controls | Risk Factors for Barrett’s Esophagus Compared Between African Americans and Non-Hispanic Whites | 1952 | OR:1.73 | 1.10-2.73 | 0.02 |
use of proton inhibitor pump | Theresa H. Nguyen8 | cases and controls | Risk Factors for Barrett’s Esophagus Compared Between African Americans and Non-Hispanic Whites | 1952 | OR:1.88 | 1.40-2.52 | <0.001 |
use of proton inhibitor pump | Hirohiko Shinkai15 | cases and controls | Association between the Body Mass Index and the Risk of Barrett’s Esophagus in Japan | 113 | OR:8.28 | 2.96-123.1 | 0.01 |
Presence of belching | Praveen Mathew20 | cases and controls | Risk factors for Barrett’s esophagus in Indian patients with gastroesophageal reflux disease | 278 | OR:2.28 | 1.11-4.66 | 0.02 |
motor disorder of the esophagus | Camille Bazin19 | cases and controls | Esophageal Motor Disorders Are a Strong and Independant Associated Factor of Barrett’s Esophagus | 201 | OR:4.49 | 1.85-10.93 | <0.001 |
GER | Yousaf Bashir Hadi4 | cases and controls | Independent association of obstructive sleep apnea with Barrett’s esophagus | 1091 | OR:2.23 | 1.45-3.49 | 0.01 |
GER | Cadman L. Leggett21 | cases and controls | Obstructive Sleep Apnea Is a Risk Factor for Barrett’s Esophagus | 7482 | OR:3.4 | 1.9-6.0 | <.0001 |
GER | Jiro Watari22 | cases and controls (Cases vs without PPI) | Association between obesity and Barrett’s esophagus in a Japanese population: a hospital-based, cross-sectional study | 1581 | OR:3.48 | 1.89-6.41 | <0.0001 |
GER | Jiro Watari22 | cases and controls (Cases vs PPI) | Association between obesity and Barrett’s esophagus in a Japanese population: a hospital-based, cross-sectional study | 1581 | OR:5.67 | 2.17-14.86 | 0.0004 |
Age of presentation of GER symptom under 30 years | Omar Bakr23 | cases and controls ( Cases vs Population) | Gastroesophageal Reflux Frequency, Severity, Age of Onset, Family History and Acid Suppressive Therapy Predict Barrett’s Esophagus in a Large Population | 317 | OR:2.93 | 1.67-5.15 | |
Age of presentation of GER symptom under 30 years | Omar Bakr23 | cases and controls (Cases vs Patients with GER) | Gastroesophageal Reflux Frequency, Severity, Age of Onset, Family History and Acid Suppressive Therapy Predict Barrett’s Esophagus in a Large Population | 316 | OR:1.93 | 1.15-3.22 | |
Nighttime symptoms of GER | Omar Bakr23 | cases and controls (Cases vs Population) | Gastroesophageal Reflux Frequency, Severity, Age of Onset, Family History and Acid Suppressive Therapy Predict Barrett’s Esophagus in a Large Population | 317 | OR:5.40 | 3.81-7.72 | |
feeling stuck | Omar Bakr23 | cases and controls (Cases vs Population) | Gastroesophageal Reflux Frequency, Severity, Age of Onset, Family History and Acid Suppressive Therapy Predict Barrett’s Esophagus in a Large Population | 317 | OR:3.00 | 2.13-4.24 | |
Family history of GER | Omar Bakr23 | cases and controls (Cases vs Population) | Gastroesophageal Reflux Frequency, Severity, Age of Onset, Family History and Acid Suppressive Therapy Predict Barrett’s Esophagus in a Large Population | 317 | OR:2.55 | 1.80-3.62 | |
BE family history | Omar Bakr23 | cases and controls (Cases vs Population) | Gastroesophageal Reflux Frequency, Severity, Age of Onset, Family History and Acid Suppressive Therapy Predict Barrett’s Esophagus in a Large Population | 317 | OR:10.08 | 2.83-35.84 | |
BE family history | Omar Bakr23 | cases and controls (Cases vs Patients with GER) | Gastroesophageal Reflux Frequency, Severity, Age of Onset, Family History and Acid Suppressive Therapy Predict Barrett’s Esophagus in a Large Population | 316 | OR:3.64 | 1.50-8.83 | |
1-2 appointments per year for GER | Omar Bakr23 | cases and controls (Cases vs Population) | Gastroesophageal Reflux Frequency, Severity, Age of Onset, Family History and Acid Suppressive Therapy Predict Barrett’s Esophagus in a Large Population | 317 | OR:7.13 | 4.71-10.81 | |
more than 3 appointments per year for GER | Omar Bakr23 | cases and controls (Cases vs Population) | Gastroesophageal Reflux Frequency, Severity, Age of Onset, Family History and Acid Suppressive Therapy Predict Barrett’s Esophagus in a Large Population | 317 | OR:5.12 | 2.96-8.83 | |
3-5 appointments per year for any reason | Omar Bakr23 | cases and controls (Cases vs Population) | Gastroesophageal Reflux Frequency, Severity, Age of Onset, Family History and Acid Suppressive Therapy Predict Barrett’s Esophagus in a Large Population | 317 | OR:2.06 | 1.40-3.03 | |
6-10 appointments per year for any reason | Omar Bakr23 | cases and controls (Cases vs Population) | Gastroesophageal Reflux Frequency, Severity, Age of Onset, Family History and Acid Suppressive Therapy Predict Barrett’s Esophagus in a Large Population | 317 | OR:2.69 | 1.65-4.37 | |
more than 10 visits per year for any reason | Omar Bakr23 | cases and controls (Cases vs Population) | Gastroesophageal Reflux Frequency, Severity, Age of Onset, Family History and Acid Suppressive Therapy Predict Barrett’s Esophagus in a Large Population | 317 | OR:2.25 | 1.33-3.83 | |
Human papillomavirus DNA | M. YW Wong24 | cases and controls | Human papillomavirus exposure and sexual behavior are significant risk factors for Barrett’s dysplasia/esophageal adenocarcinoma | 133 | OR:8.2 | 2.8-23.8 | 0.0001 |
obstructive sleep apnea | Yousaf Bashir Hadi4 | cases and controls | Independent association of obstructive sleep apnea with Barrett’s esophagus | 1091 | OR:3.26 | 1.72-6.85 | <0.01 |
obstructive sleep apnea | Cadman L. Leggett21 | cases and controls | Obstructive Sleep Apnea Is a Risk Factor for Barrett’s Esophagus | 7482 | OR:1.8 | 1.1-3.2 | 0.03 |
erosive esophagitis | Atsuhiro Masuda11 | Cohort study | Influence of hiatal hernia and male sex on the relationship between alcohol intake and occurrence of Barrett’s esophagus | 8031 | OR:2.82 | 2.04-3.85 | <0.0001 |
erosive esophagitis | Hirohiko Shinkai15 | cases and controls | Association between the Body Mass Index and the Risk of Barrett’s Esophagus in Japan | 113 | 15.3 | 3.49-66.8 | 0.01 |
esophagitis | Gloria Vargas Cárdenas14 | cases and controls | Esófago de Barrett: Prevalencia y Factores de Riesgo en el Hospital Nacional “Arzobispo Loayza” Lima-Perú | 11,970 | 14.81 | 3.96- 55.41 | 0.001 |
Grade B esophagitis (LA) | Emery C Lin5 | Cohort study | Low Prevalence of Suspected Barrett’s Esophagus in Gastroesophageal Reflux Disease Without Alarm Symptoms | 4122 | OR:2.19 | 1.72 - 2.78 | |
grade C / D esophagitis (LA) | Emery C Lin5 | Cohort study | Low Prevalence of Suspected Barrett’s Esophagus in Gastroesophageal Reflux Disease Without Alarm Symptoms | 4122 | OR:3.50 | 2.59 - 4.73 | |
Premature birth | Seiji Shiota25 | Cohort study | Premature Birth and Large for Gestational Age Are Associated with Risk of Barrett’s Esophagus in Adults | 1679 | OR:4.08 | 1.38 - 12.05 | |
Lifestyle (sexual intercourse, consumption of food and drink, tobacco, alcohol) | |||||||
Person in a sexual relationship | M. YW Wong24 | cases and controls | Human papillomavirus exposure and sexual behavior are significant risk factors for Barrett’s dysplasia/esophageal adenocarcinoma | 133 | OR:11.4 | 1.4-93.9 | 0.02 |
more than 6 oral sex partners | M. YW Wong24 | cases and controls | Human papillomavirus exposure and sexual behavior are significant risk factors for Barrett’s dysplasia/esophageal adenocarcinoma | 133 | OR:4.0 | 1.2-13.7 | 0.046 |
alcohol consumption | Atsuhiro Masuda11 | Cohort study | Influence of hiatal hernia and male sex on the relationship between alcohol intake and occurrence of Barrett’s esophagus | 8031 | OR:1.92 | 1.41-2.61 | <0.0001 |
Hot tea consumption | Yan-Hua Chen6 | Cohort study | Prevalence and risk factors for Barrett’s esophagus in Taiwan | 3385 | OR:1.695 | 1.043-2.754 | 0.033 |
Always use a cigarette | Wytske M. Westra13 | cases and controls (Cigarette and smokeless tobacco users vs Non-users) | Smokeless Tobacco and Cigar and/or Pipe Are Risk Factors for Barrett Esophagus in Male Patients With Gastroesophageal Reflux Disease | 1015 | OR:1.43 | 1.06-1.88 | 0.02 |
Always use cigarettes and smokeless tobacco | Wytske M. Westra13 | cases and controls (Cigarette and smokeless tobacco users vs Non-users) | Smokeless Tobacco and Cigar and/or Pipe Are Risk Factors for Barrett Esophagus in Male Patients With Gastroesophageal Reflux Disease | 1015 | OR:2.53 | 1.22-5.22 | 0.01 |
Always use a cigarette | Wytske M. Westra13 | cases and controls (Cigarette and cigar users vs Non-users) | Smokeless Tobacco and Cigar and/or Pipe Are Risk Factors for Barrett Esophagus in Male Patients With Gastroesophageal Reflux Disease | 1015 | OR:1.43 | 1.07-1.91 | 0.02 |
Always consume cigarette and cigar | Wytske M. Westra13 | cases and controls (Cigarette and cigar users vs Non-users) | Smokeless Tobacco and Cigar and/or Pipe Are Risk Factors for Barrett Esophagus in Male Patients With Gastroesophageal Reflux Disease | 1015 | OR:1.90 | 1.03-3.58 | 0.04 |
consumption of fatty foods | Gloria Vargas Cárdenas14 | cases and controls | Esófago de Barrett: Prevalencia y Factores de Riesgo en el Hospital Nacional “Arzobispo Loayza” Lima-Perú | 11,970 | OR:8.67 | 2.28-32.99 | 0.001 |
The most consistent risk factors in the articles reviewed are male, increased age, metabolic syndrome, hiatal hernia, use of proton pump inhibitors, gastroesophageal reflux (GER), obstructive sleep apnea and erosive esophagitis. Central obesity, diabetes, active gastritis, presence of belching, esophageal motor disorder, human papillomavirus DNA, alcohol consumption, tobacco use, consumption of hot tea and consumption of fatty foods are risk factors with only one study showing confirms the association with Barret's esophagus, which should be further studied.
DISCUSSION
According to the demographic characteristics, for several authors, being a male is a risk factor for Barret's esophagus4,5,6,7,8,9. Although Matheus Degiovani et al, say that being a female is a risk factor for Barret's esophagus10. According to many authors, increased age is a risk factor4,6,7,9,10,11,12,13,14. Although Emery C Lin et al, found that the OR increases constantly from 40 years to 69 years where their OR is 1.68.5
With regard to presentation and clinical data, according to Shou-wu Lee et al and Cadman L. Leggett et al, metabolic syndrome is a risk factor for Barret's esophagus.16,17Other authors have found other components of the metabolic syndrome triad as risk factors, such as Chih-Cheng Chen et al, who mentioned that central obesity is a risk factor for Barrett's esophagus.18
According to several authors, hiatal hernia is a risk factor for Barret's esophagus5,6,11,19,20. Although Theresa H. Nguyen distinguishes the size of the hiatal hernia considering that one greater than or equal to 3 cm is more likely to have Barret's esophagus8
According to Yousaf Bashir Hadi et al, Cadman L. Leggett et al and Jiro Watari et al, GER is a risk factor for Barret's esophagus4,21,22. Although Omar Bakr et al, mentions that both the age of presentation, symptoms, family history and the number of consultations made for GER could also be risk factors.23Furthermore, Theresa H. Nguyen et al and Hirohiko Shinkai et al , tells us that the use of proton pump inhibitors is a risk factor for Barret's esophagus8,15.
Conforming to Yousaf Bashir Hadi et al, Cadman L. Leggett et al, obstructive sleep apnea is a risk factor for Barrett's esophagus.4,21
According to Atsuhiro Masuda et al and Hirohiko Shinkai et al, erosive esophagitis is a risk factor for Barret's esophagus.11,15Although for Gloria Vargas Cárdenas et al, only the fact of having esophagitis would already be a risk factor14, on the other hand for Emery C Lin et al, they mention that only grade B, C, D esophagitis are a risk factor for Barret's esophagus5. Lifestyles are not as well studied as a risk factor for which more studies should be carried out.
CONCLUSIONS
An association of multiple risk factors with Barret's esophagus is evidenced in hospitalized patients. The risk factors associated with Barret's esophagus in the review that were the most concordant are male sex, increased age, metabolic syndrome, hiatal hernia, use of proton pump inhibitors, gastroesophageal reflux (GER), obstructive sleep apnea and erosive esophagitis.
REFERENCES
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2. Que, Jianwen, Katherine S. Garman, Rhonda F. Souza, y Stuart Jon Spechler. "Pathogenesis and Cells of Origin of Barrett's Esophagus". Gastroenterology 157, n.o 2 (2019): 349-364.e1. https://doi.org/10.1053/j.gastro.2019.03.072 [ Links ]
3. Clermont, Michelle, y Gary W. Falk. "Clinical Guidelines Update on the Diagnosis and Management of Barrett's Esophagus". Digestive Diseases and Sciences 63, n.o 8 (agosto de 2018): 2122-28. https://doi.org/10.1007/s10620-018-5070-z. [ Links ]
4. Hadi, Yousaf Bashir, Adnan Aman Khan, Syeda Fatima Zehra Naqvi, y Justin Thomas Kupec. "Independent Association of Obstructive Sleep Apnea with Barrett's Esophagus". Journal of Gastroenterology and Hepatology 35, n.o 3 (marzo de 2020): 408-11. https://doi.org/10.1111/jgh.14779. [ Links ]
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Received: October 01, 2020; Accepted: December 04, 2020