Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2016; 22(35): 8060-8066
Published online Sep 21, 2016. doi: 10.3748/wjg.v22.i35.8060
Trajectories of endoscopic Barrett esophagus: Chronological changes in a community-based cohort
Shouji Shimoyama, Toshihisa Ogawa, Toshiyuki Toma
Shouji Shimoyama, Toshihisa Ogawa, Toshiyuki Toma, Gastrointestinal Unit, Settlement Clinic, Adachi-ku, Tokyo 120-0003, Japan
Author contributions: Shimoyama S designed and performed the research, analyzed the data, and wrote the paper; Ogawa T and Toma T performed the research.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Shouji Shimoyama, Gastrointestinal Unit, Settlement Clinic, 4-20-7, Towa, Adachi-ku, Tokyo 120-0003, Japan. shimoyama@apost.plala.or.jp
Telephone: +81-3-36057747 Fax: +81-3-36050244
Received: May 29, 2016
Peer-review started: May 29, 2016
First decision: June 20, 2016
Revised: June 30, 2016
Accepted: August 5, 2016
Article in press: August 5, 2016
Published online: September 21, 2016
Processing time: 108 Days and 7.6 Hours
Abstract
AIM

To elucidate longitudinal changes of an endoscopic Barrett esophagus (BE), especially of short segment endoscopic BE (SSBE).

METHODS

This study comprised 779 patients who underwent two or more endoscopies between January 2009 and December 2015. The intervals between the first and the last endoscopy were at least 6 mo. The diagnosis of endoscopic BE was based on the criteria proposed by the Japan Esophageal Society and was classified as long segment (LSBE) and SSBE, the latter being further divided into partial and circumferential types. The potential background factors that were deemed to affect BE change included age, gender, antacid therapy use, gastroesophageal reflux disease-suggested symptoms, esophagitis, and hiatus hernia. Time trends of a new appearance and complete regression were investigated by Kaplan-Meier curves. The factors that may affect appearance and complete regression were investigated by χ2 and Student-t tests, and multivariable Cox regression analysis.

RESULTS

Incidences of SSBE and LSBE were respectively 21.7% and 0%, with a mean age of 68 years. Complete regression of SSBE was observed in 61.5% of initial SSBE patients, while 12.1% of initially disease free patients experienced an appearance of SSBE. Complete regressions and appearances of BE occurred constantly over time, accounting for 80% and 17% of 5-year cumulative rates. No LSBE development from SSBE was observed. A hiatus hernia was the only significant factor that facilitated BE development (P = 0.03) or hampered (P = 0.007) BE regression.

CONCLUSION

Both appearances and complete regressions of SSBE occurred over time. A hiatus hernia was the only significant factor affecting the BE story.

Keywords: Barrett esophagus; Longitudinal vessels; Progression; Regression; Hiatus hernia

Core tip: The authors demonstrated that the appearance or complete regression of Barrett esophagus (BE) occurs constantly over time. Both phenomena are associated with a hiatus hernia but not gastroesophageal reflux disease (GERD)-suggested symptoms, suggesting that the appearance of BE occurs silently. These findings imply that a lack of GERD-suggested symptoms is not sufficient to exclude patients from screening an upper gastrointestinal endoscopy for identifying BE. The endoscopists should bear in mind that, along with the silent BE story, they should not miss the chance for the detection of BE and subsequent esophageal adenocarcinoma at an early, presymptomatic stage.