Research Report
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World J Gastroenterol. Apr 21, 2014; 20(15): 4353-4361
Published online Apr 21, 2014. doi: 10.3748/wjg.v20.i15.4353
Risk factors associated with Barrett’s epithelial dysplasia
Mikiko Fujita, Yuri Nakamura, Saeko Kasashima, Maiko Furukawa, Ryoichi Misaka, Hikaru Nagahara
Mikiko Fujita, Yuri Nakamura, Saeko Kasashima, Maiko Furukawa, Ryoichi Misaka, Hikaru Nagahara, Department of Gastroenterology, Aoyama Hospital, Tokyo Women’s Medical University, Tokyo 1070061, Japan
Author contributions: Fujita M, Misaka R and Nagahara H designed the study and wrote the manuscript; Fujita M, Nakamura Y, Kasashima S and and Furukawa M performed the endoscopic diagnosis and acquired the data; Misaka R and Nagahara H analyzed and interpreted the data; Nagahara H gave final approval to the version to be published.
Correspondence to: Hikaru Nagahara, Professor, Department of Gastroenterology, Aoyama Hospital, Tokyo Women’s Medical University, 2-7-13 Kitaaoyama, Minato-ku, Tokyo 1070061, Japan. nagahara.hikaru@twmu.ac.jp
Telephone: +81-3-54118111 Fax: +81-3-54118126
Received: September 5, 2013
Revised: October 27, 2013
Accepted: November 18, 2013
Published online: April 21, 2014
Processing time: 223 Days and 14.6 Hours
Abstract

AIM: To elucidate risk factors associated with dysplasia of short-segment Barrett’s esophagus (BE).

METHODS: A total of 151 BE patients who underwent endoscopic examination from 2004 to 2008 in Aoyama Hospital, Tokyo Women’s Medical University, Japan and whose diagnosis was confirmed from biopsy specimens were enrolled in the study. BE was diagnosed based on endoscopic findings of gastric-appearing mucosa or apparent columnar-lined esophagus proximal to the esophagogastric junction. Dysplasia was classified into three grades - mild, moderate and severe - according to the guidelines of the Vienna Classification System for gastrointestinal epithelial neoplasia. Anthropometric and biochemical data were analyzed to identify risk factors for BE dysplasia. The prevalence of Helicobacter pylori (H. pylori) infection and the expression of p53 by immunohistological staining were also investigated.

RESULTS: Histological examination classified patients into three types: specialized columnar epithelium (SCE) (n = 65); junctional (n = 38); and gastric fundic (n = 48). The incidence of dysplasia or adenocarcinoma from BE of the SCE type was significantly higher than that of the other two types (P < 0.01). The univariate analysis revealed that sex, H. pylori infection, body weight, p53 overexpression, and low diastolic blood pressure (BP) were associated with BE dysplasia. In contrast, body mass index, waist circumference, metabolic syndrome complications, and variables related to glucose or lipid metabolism were not associated with dysplasia. Multivariate logistic analysis showed that overexpression of p53 [odds ratio (OR) = 13.1, P = 0.004], H. pylori infection (OR = 0.19, P = 0.066), and diastolic BP (OR = 0.87, P = 0.021) were independent risk factors for epithelial dysplasia in BE patients with the SCE type.

CONCLUSION: Overexpression of p53 is a risk factor for dysplasia of BE, however, H. pylori infection and diastolic BP inversely associated with BE dysplasia might be protective.

Keywords: Barrett’s esophagus; Dysplasia; Helicobacter pylori; p53; Risk factors

Core tip: Barrett’s esophagus (BE) is known to be a precancerous state of adenocarcinoma will become common in Asian countries, therefore, it is important to establish a high-risk group or strategy for screening or follow-up of BE. We present here the results of univariate and multivariate analysis to identify variables associated with dysplasia of BE. p53 expression in immunohistochemistry was associated with dysplasia, and Helicobacter pylori infection and high diastolic blood pressure may act as protective factors against dysplastic change of BE. These three factors may be candidates to establish a high-risk group for esophageal adenocarcinoma.