Subscribe to RSS
DOI: 10.1055/s-2007-966737
© Georg Thieme Verlag KG Stuttgart · New York
Predicting presence of intestinal metaplasia and dysplasia in columnar-lined esophagus: a multivariate analysis
Publication History
submitted 30 December 2006
accepted after revision 24 April 2007
Publication Date:
17 August 2007 (online)
![](https://www.thieme-connect.de/media/endoscopy/200709/lookinside/thumbnails/10.1055-s-2007-966737-1.jpg)
Background and study aims: In patients with presumed Barrett esophagus we evaluated clinical risk factors that could predict the presence of intestinal metaplasia and dysplasia in biopsies of columnar-lined esophagus (CLE), independently of histological results.
Patients and methods: In 908 patients with CLE of length ≥ 2 cm, data on age, sex, reflux symptoms, tobacco and alcohol use, medication use, and upper gastrointestinal endoscopy findings were prospectively collected. Multivariate logistic regression analysis was performed, and a model for predicting the histological results was developed.
Results: In 127/908 patients, biopsies of CLE did not contain intestinal metaplasia. Of the 781 patients with intestinal metaplasia, 663 patients (85 %) had no dysplasia, and 118 (15 %) had low grade dysplasia (LGD). The most important predictors for the presence of intestinal metaplasia were length of CLE, size of hiatal hernia, and male sex, while among those with intestinal metaplasia, age and male sex were most important for the presence of LGD. Multivariate combinations of these predictors yielded reliable models, which were able to discriminate intestinal metaplasia well from no intestinal metaplasia (area under receiver operating characteristic [ROC] curve 0.82), but only reasonably discriminated LGD from no dysplasia (area under ROC 0.65).
Conclusions: A simple model based on clinical findings can be used to predict the presence of intestinal metaplasia in biopsies from CLE. In contrast, predicting the presence of LGD versus no dysplasia in intestinal metaplasia is more difficult. Predictions from these models may aid decision making on whether a patient with CLE should have surveillance, in view of the known sampling error at endoscopy and interobserver variability at histology.
References
- 1 Avidan B, Sonnenberg A, Schnell T G. et al . Hiatal hernia and acid reflux frequency predict presence and length of Barrett’s esophagus. Dig Dis Sci. 2002; 47 256-264
- 2 Guillem P G. How to make a Barrett esophagus: pathophysiology of columnar metaplasia of the esophagus. Dig Dis Sci. 2005; 50 415-424
- 3 Paull A, Trier J S, Dalton M D. et al . The histologic spectrum of Barrett’s esophagus. N Engl J Med. 1976; 295 476-480
- 4 Chandrasoma P T, Lokuhetty D M, Demeester T R. et al . Definition of histopathologic changes in gastroesophageal reflux disease. Am J Surg Pathol. 2000; 24 344-351
- 5 Falk G W. Barrett’s esophagus. Gastroenterology. 2002; 122 1569-1591
- 6 Hamilton S R, Smith R R. The relationship between columnar epithelial dysplasia and invasive adenocarcinoma arising in Barrett’s esophagus. Am J Clin Pathol. 1987; 87 301-312
- 7 Sampliner R E. Updated guidelines for the diagnosis, surveillance, and therapy of Barrett’s esophagus. Am J Gastroenterol. 2002; 97 1888-1895
- 8 Oberg S, Johansson J, Wenner J. et al . Endoscopic surveillance of columnar-lined esophagus: frequency of intestinal metaplasia detection and impact of antireflux surgery. Ann Surg. 2001; 234 619-626
- 9 Kerkhof M, Bax D A, Moons L MG. et al . CDX2 expression predicts Barrett’s metaplasia in oesophageal columnar epithelium without goblet cells. Aliment Pharmacol Ther. 2006; 24 1613-1621
- 10 Campos G M, DeMeester S R, Peters J H. et al . Predictive factors of Barrett esophagus: multivariate analysis of 502 patients with gastroesophageal reflux disease. Arch Surg. 2001; 136 1267-1273
- 11 Cameron A J. Barrett’s esophagus: prevalence and size of hiatal hernia. Am J Gastroenterol. 1999; 94 2054-2059
- 12 Conio M, Filiberti R, Blanchi S. et al . Risk factors for Barrett’s esophagus: a case-control study. Int J Cancer. 2002; 97 225-229
- 13 Aste H, Bonelli L, Ferraris R. et al . Gastroesophageal reflux disease: relationship between clinical and histological features. GOSPE. Gruppo Operativo per lo Studio delle Precancerosi dell’Esofago. Dig Dis Sci. 1999; 44 2412-2418
- 14 Haggitt R C. Barrett’s esophagus, dysplasia, and adenocarcinoma. Hum Pathol. 1994; 25 982-993
- 15 Hameeteman W, Tytgat G N, Houthoff H J. et al . Barrett’s esophagus: development of dysplasia and adenocarcinoma. Gastroenterology. 1989; 96 1249-1256
- 16 Buttar N S, Wang K K. Mechanisms of disease: carcinogenesis in Barrett’s esophagus. Nat Clin Pract Gastroenterol Hepatol. 2004; 1 106-112
- 17 Hage M, Siersema P D, van Dekken H. et al . Oesophageal cancer incidence and mortality in patients with long-segment Barrett’s oesophagus after a mean follow-up of 12.7 years. Scand J Gastroenterol. 2004; 39 1175-1179
- 18 Mashimo H, Wagh M S, Goyal R K. Surveillance and screening for Barrett esophagus and adenocarcinoma. J Clin Gastroenterol. 2005; 39 S33-41
- 19 Kerkhof M, van Dekken H, Steyerberg E W. et al . Grading of dysplasia in Barrett’s oesophagus: substantial interobserver variation between general and gastrointestinal pathologists. Histopathology. 2007; 50 920-927
- 20 Montgomery E, Bronner M P, Goldblum J R. et al . Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation. Hum Pathol. 2001; 32 368-378
- 21 Gopal D V, Lieberman D A, Magaret N. et al . Risk factors for dysplasia in patients with Barrett’s esophagus (BE): results from a multicenter consortium. Dig Dis Sci. 2003; 48 1537-1541
- 22 Avidan B, Sonnenberg A, Schnell T G. et al . Hiatal hernia size, Barrett’s length, and severity of acid reflux are all risk factors for esophageal adenocarcinoma. Am J Gastroenterol. 2002; 97 1930-1936
- 23 Rath H C, Timmer A, Kunkel C. et al . Comparison of interobserver agreement for different scoring systems for reflux esophagitis: impact of level of experience. Gastrointest Endosc. 2004; 60 44-49
- 24 Sharma P, McQuaid K, Dent J. et al . A critical review of the diagnosis and management of Barrett’s esophagus: the AGA Chicago Workshop. Gastroenterology. 2004; 127 310-330
- 25 Reid B J, Haggitt R C, Rubin C E. et al . Observer variation in the diagnosis of dysplasia in Barrett’s esophagus. Hum Pathol. 1988; 19 166-178
- 26 Steyerberg E W, Eijkemans M J, Harrell Jr F E. et al. Prognostic modelling with logistic regression analysis: a comparison of selection and estimation methods in small data sets. Stat Med. 2000; 19 1059-1079
- 27 Nagelkerke N JD. A note on a general definition of the coefficient of determination. Biometrika. 1991; 78 691-692
- 28 Harrell F E. Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. New York:. Springer; 2001 xxii, 568
- 29 Steyerberg E W, Harrell Jr F E, Borsboom G J. et al . Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. J Clin Epidemiol. 2001; 54 774-781
- 30 Dickman R, Green C, Chey W D. et al . Clinical predictors of Barrett’s esophagus length. Gastrointest Endosc. 2005; 62 675-681
- 31 de Jonge P J, Steyerberg E W, Kuipers E J. et al . Risk factors for the development of esophageal adenocarcinoma in Barrett’s esophagus. Am J Gastroenterol. 2006; 101 1421-1429
- 32 Stein D J, El-Serag H B, Kuczynski J. et al . The association of body mass index with Barrett’s oesophagus. Aliment Pharmacol Ther. 2005; 22 1005-1010
- 33 Lagergren J, Bergstrom R, Nyren O. Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med. 1999; 130 883-890
- 34 Chow W H, Blot W J, Vaughan T L. et al . Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst. 1998; 90 150-155
- 35 Bu X, Ma Y, Der R. et al . Body mass index is associated with Barrett esophagus and cardiac mucosal metaplasia. Dig Dis Sci. 2006; 51 1589-1594
- 36 Provenzale D, Schmitt C, Wong J B. Barrett’s esophagus: a new look at surveillance based on emerging estimates of cancer risk. Am J Gastroenterol. 1999; 94 2043-2053
- 37 Shaheen N J, Provenzale D, Sandler R S. Upper endoscopy as a screening and surveillance tool in esophageal adenocarcinoma: a review of the evidence. Am J Gastroenterol. 2002; 97 1319-1327
- 38 Rudolph R E, Vaughan T L, Storer B E. et al . Effect of segment length on risk for neoplastic progression in patients with Barrett esophagus. Ann Intern Med. 2000; 132 612-620
- 39 Guda N M, Partington S, Vakil N. Inter- and intra-observer variability in the measurement of length at endoscopy: Implications for the measurement of Barrett’s esophagus. Gastrointest Endosc. 2004; 59 655-658
M. Kerkhof, MD
Department of Gastroenterology and Hepatology
Erasmus MC - University Medical Center Rotterdam
PO Box 2040
3000 CA Rotterdam
The Netherlands
Fax: +31-10-4634682
Email: m.kerkhof@erasmusmc.nl