Risk factors for Barrett's oesophagus

risk factors

Several risk factors have been identified for the development of Barrett's oesophagus (1,2,3):

• older age – > 50 years, rare in children
• white race - uncommon in blacks and Asians
• male sex - two to three times as common in men as in women
• chronic heartburn
• age<30 years at onset of GORD symptoms
• hiatal hernia
• erosive oesophagitis
• obesity with intrabdominal fat distribution
• metabolic syndrome
• tobacco use
• family history of GORD, Barrett's oesophagus or oesophageal adenocarcinoma
• obstructive sleep apnoea
• consumption of red meat and processed meat

Factors which might provide protection against Barrett's oesophagus include:

• nonsteroidal antiinflammatory drugs - although this has been questioned and a study suggested that "use of NSAIDs was not associated with a reduced risk of Barrett's oesophagus. It is likely that the protective mechanism of NSAIDs on oesophageal adenocarcinoma occurs subsequent to the development of Barrett's oesophagus." (4)
• gastric infection with Helicobacter pylori
• consumption of a diet high in fruits and vegetables (1)

Known risk factors for the development of neoplasia in Barrett's oesophagus include:

• advancing age
• increasing length of Barrett's oesophagus
  • longer Barrett’s oesophagus segments are associated with increased risk of progression to oesophageal adenocarcinoma
• central obesity
• tobacco usage
• lack of NSAIDs use
• lack of PPI use
• lack of statin use (2)

There is no evidence that alcohol consumption is associated with risk of Barrett's oesophagus (3).

Reference:

• (1) Spechler SJ, Souza RF. Barrett's esophagus. N Engl J Med. 2014;371(9):836-45.
• (2) Shaheen NJ et al. ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus. Am J Gastroenterol. 2016;111(1):30-50
• (3) Pophali P, Halland M. Barrett's oesophagus: diagnosis and management. BMJ. 2016;353:i2373
• (4) Khalaf N et al. Nonsteroidal anti-inflammatory drugs and the risk of Barrett's esophagus.Clin Gastroenterol Hepatol. 2014 Nov;12(11):1832-9.