review article risk factors associated with barrett's

13
Pág. 186 RISK FACTORS ASSOCIATED WITH BARRETT'S ESOPHAGUS IN HOSPITALIZED PATIENTS Gerard Gomez 1 FACTORES DE RIESGO ASOCIADOS A ESÓFAGO DE BARRETT EN PACIENTES HOSPITALIZADOS Facultad de Medicina Humana URP ISSN Versión Online: 2308-0531 Rev. Fac. Med. Hum. January 2021;21(1):186-198. DOI 10.25176/RFMH.v21i1.3119 REVIEW ARTICLE 1 Instituto de Investigación en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú. Cite as: Gerard Gomez. Risk factors associated with barrett's esophagus in hospitalized patients. Rev. Fac. Med. Hum. Enero 2021; 21(1):186- 198. DOI 10.25176/RFMH.v21i1.3119 ABSTRACT Objective: The objective of this article is to carry out a systematic review of scientific articles that reveal the risk factors associated with Barrett's esophagus in hospitalized patients. Methods: The review was performed by electronic search for articles related to risk factors associated with Barrett's esophagus in hospitalized patients. The PEO question was: What are the risk factors associated with Barrett's esophagus in hospitalized patients? The search sources were in PUBMED. The search terms were: Risk Factors; Barrett'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 Barrett's esophagus according to demographic characteristics and patient traits, presentation, and clinical data and lifestyles. Conclusion: An association of various risk factors with Barrett's esophagus is evidenced in hospitalized patients. The most concordant risk factors associated with Barrett'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; Barrett's esophagus; Patients (source: MeSH NLM). RESUMEN Objetivo: El objetivo de este artículo es realizar una revisión sistemática de artículos científicos que revelen los factores de riesgo asociados a Esófago de Barrett en pacientes hospitalizados. Métodos: La revisión fue efectuada mediante búsqueda electrónica de artículos relacionados a factores de riesgo asociadas a Esófago de Barrett en pacientes hospitalizados. La pregunta PEO fue ¿Cuáles son los factores de riesgo asociados a Esófago de Barrett en pacientes hospitalizados? Las fuentes de búsqueda fueron en PUBMED. Los términos de búsqueda fueron: Factores de Riesgo; Esófago de Barrett; pacientes hospitalizados. Para esta revisión se seleccionaron los artículos publicados a partir el año 2010 que tuvieron experiencias investigativas y aspectos teórico-conceptuales. Resultados: De los 389 resultados encontrados con fuentes de indexación, se seleccionaron un total de 25 artículos donde 22 artículos contenían resultados de investigación y 3 fueron considerados para aspectos teórico – conceptuales que se relacionan con el propósito del estudio. La búsqueda dio como resultado factores de riesgo asociados a Esófago de Barrett según las características demográficas y rasgos del paciente, presentación y datos clínicos y estilos de vida. Conclusión: Se evidencia una asociación de diversos factores de riesgo con Esófago de Barrett en pacientes hospitalizados. Los factores de riesgo asociados a Esófago de Barrett en la revisión que fueron más concordantes son sexo masculino, edad incrementada, síndrome metabólico, hernia hiatal, uso de inhibidores de bomba de protones, reflujo gastroesofágico(RGE), apnea obstructiva del sueño y esofagitis erosiva. Palabras clave: Factores de Riesgo; Esófago de Barrett; Pacientes (fuente: DeCS BIREME). REVIEW ARTICLE Journal home page: http://revistas.urp.edu.pe/index.php/RFMH Article published by the Magazine of the Faculty of Human Medicine of the Ricardo Palma University. It is an open access article, distributed under the terms of the Creative Commons License: Creative Commons Attribution 4.0 International, CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/), that allows non-commercial use, distribution and reproduction in any medium, provided that the original work is duly cited. For commercial use, please contact [email protected]

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Page 1: REVIEW ARTICLE RISK FACTORS ASSOCIATED WITH BARRETT'S

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RISK FACTORS ASSOCIATED WITH BARRETT'S ESOPHAGUS IN HOSPITALIZED PATIENTS

Gerard Gomez 1

FACTORES DE RIESGO ASOCIADOS A ESÓFAGO DE BARRETT EN PACIENTES HOSPITALIZADOS

Facultad de Medicina Humana URPISSN Versión Online: 2308-0531Rev. Fac. Med. Hum. January 2021;21(1):186-198.

DOI 10.25176/RFMH.v21i1.3119REVIEW ARTICLE

1 Instituto de Investigación en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú.

Cite as: Gerard Gomez. Risk factors associated with barrett's esophagus in hospitalized patients. Rev. Fac. Med. Hum. Enero 2021; 21(1):186-198. DOI 10.25176/RFMH.v21i1.3119

ABSTRACTObjective: The objective of this article is to carry out a systematic review of scientific articles that reveal the risk factors associated with Barrett's esophagus in hospitalized patients. Methods: The review was performed by electronic search for articles related to risk factors associated with Barrett's esophagus in hospitalized patients. The PEO question was: What are the risk factors associated with Barrett's esophagus in hospitalized patients? The search sources were in PUBMED. The search terms were: Risk Factors; Barrett'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 Barrett's esophagus according to demographic characteristics and patient traits, presentation, and clinical data and lifestyles. Conclusion: An association of various risk factors with Barrett's esophagus is evidenced in hospitalized patients. The most concordant risk factors associated with Barrett'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; Barrett's esophagus; Patients (source: MeSH NLM).

RESUMENObjetivo: El objetivo de este artículo es realizar una revisión sistemática de artículos científicos que revelen los factores de riesgo asociados a Esófago de Barrett en pacientes hospitalizados. Métodos: La revisión fue efectuada mediante búsqueda electrónica de artículos relacionados a factores de riesgo asociadas a Esófago de Barrett en pacientes hospitalizados. La pregunta PEO fue ¿Cuáles son los factores de riesgo asociados a Esófago de Barrett en pacientes hospitalizados? Las fuentes de búsqueda fueron en PUBMED. Los términos de búsqueda fueron: Factores de Riesgo; Esófago de Barrett; pacientes hospitalizados. Para esta revisión se seleccionaron los artículos publicados a partir el año 2010 que tuvieron experiencias investigativas y aspectos teórico-conceptuales. Resultados: De los 389 resultados encontrados con fuentes de indexación, se seleccionaron un total de 25 artículos donde 22 artículos contenían resultados de investigación y 3 fueron considerados para aspectos teórico – conceptuales que se relacionan con el propósito del estudio. La búsqueda dio como resultado factores de riesgo asociados a Esófago de Barrett según las características demográficas y rasgos del paciente, presentación y datos clínicos y estilos de vida. Conclusión: Se evidencia una asociación de diversos factores de riesgo con Esófago de Barrett en pacientes hospitalizados. Los factores de riesgo asociados a Esófago de Barrett en la revisión que fueron más concordantes son sexo masculino, edad incrementada, síndrome metabólico, hernia hiatal, uso de inhibidores de bomba de protones, reflujo gastroesofágico(RGE), apnea obstructiva del sueño y esofagitis erosiva. Palabras clave: Factores de Riesgo; Esófago de Barrett; Pacientes (fuente: DeCS BIREME).

REV

IEW

ART

ICLE

Journal home page: http://revistas.urp.edu.pe/index.php/RFMH

Article published by the Magazine of the Faculty of Human Medicine of the Ricardo Palma University. It is an open access article, distributed under the terms of the Creative Commons License: Creative Commons Attribution 4.0 International, CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/), that allows non-commercial use, distribution and reproduction in any medium, provided that the original work is duly cited. For commercial use, please contact [email protected]

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INTRODUCTIONAt 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.

METHODSA 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 1 shows the process of selecting the terms for the systematic search.

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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 1 shows the

risk factors for Barret's esophagus in hospitalized patients from observational cohort studies and selected cases and controls for the review article.

Table 1. Term selection process for the PUBMED systematic search.

Figure 1. Selection process of research and theoretical-conceptual articles for the review article in PUBMED

DeCS MeSH MeSH + Entry terms

P Participants Patients “patient” [Mesh] Patients[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 Barret's esophagus

“Barrett Esophagus” [Mesh]

(Barret Metaplasia[tiab] OR Barrett Metaplasias[tiab] OR Metaplasia, Barrett[tiab] OR Metaplasias, Barrett[tiab] OR Barrett’sSyndrome[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))

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.

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Tabl

e 2.

Ris

k fa

ctor

s fo

r Bar

ret's

eso

phag

us in

hos

pita

lized

pat

ient

s fr

om o

bser

vatio

nal c

ohor

t and

cas

e-co

ntro

l stu

dies

.

Mea

sure

d ri

sk

fact

orA

utho

rSt

udy

type

Art

icle

Po

pula

tion

Mea

sure

-m

ent v

alue

CI 9

5%P

Cara

cter

isti

cas

dem

ogra

ficas

y ra

sgos

del

pac

ient

e (e

dad,

sex

o,et

nia,

,imc)

Mal

e pa

tient

Yous

af B

ashi

r Had

i (4)

case

s an

d co

ntro

lsIn

depe

nden

t ass

ocia

tion

of o

bstr

uctiv

e sl

eep

apne

a w

ithBa

rret

t’s e

soph

agus

1091

OR:

1.71

1.13

–2.5

9<0

.01

Mal

e pa

tient

Emer

y C

Lin

(5)

Coho

rt s

tudy

Low

Pre

vale

nce

of S

uspe

cted

Bar

rett

’s Es

opha

gus

in Gas

troe

soph

agea

l Refl

ux D

isea

se W

ithou

t Ala

rm

Sym

ptom

s

4122

OR:

2.61

2.

44 -

2.79

Mal

e pa

tient

Yan-

Hua

Che

n (6

)Co

hort

stu

dyPr

eval

ence

and

risk

fact

ors

for B

arre

tt’s

esop

hagu

s in

Tai

wan

3385

OR:

2.10

6 1.

145-

3.87

20.

017

Mal

e pa

tient

A. S

onne

nber

g(7)

case

s an

d co

ntro

lTh

e in

fluen

ce o

f Hel

icob

acte

r pyl

ori o

n th

e et

hnic

di

strib

utio

nof

Bar

rett

’s m

etap

lasi

a59

6 47

9O

R: 3

.34

3.28

–3.4

0<0

.000

1

Mal

e pa

tient

Ther

esa

H. N

guye

n(8)

case

s an

d co

ntro

lRi

sk F

acto

rs fo

r Bar

rett

’s Es

opha

gus

Com

pare

d Be

twee

n A

fric

an A

mer

ican

s an

d N

on-H

ispa

nic

Whi

tes

1952

OR:

3.35

1.51

–7.4

3 0.

003

Mal

e pa

tient

K. K

eyas

hian

(9)

case

s an

d co

ntro

lBa

rret

t’s e

soph

agus

in L

atin

os u

nder

goin

g en

dosc

opy

for g

astr

esop

hage

al re

flux

dise

ase

sym

ptom

s66

3O

R:2.

341.

35–4

.05

0.00

2

Mal

e pa

tient

Mat

heus

Deg

iova

ni (1

0)ca

ses

and

cont

rol

Is th

ere

a re

latio

n be

twee

n he

lyba

cter

pyl

ori a

nd

inte

stin

al m

etap

lasi

a in

sho

rt c

olum

n ep

iteliz

atio

nup

to 1

0 m

m in

the

dist

al e

soph

agus

?37

3O

R:1.

76

1.13

- 2.

760.

013

Edad

in

crem

enta

daYo

usaf

Bas

hir H

adi (4

)ca

ses

and

cont

rol

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pend

ent a

ssoc

iatio

n of

obs

truc

tive

slee

p ap

nea

with

Barr

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eso

phag

us10

91O

R:1.

041.

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.06

<0.0

1

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in

crem

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iro M

asud

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1)Co

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stu

dyIn

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f hia

tal h

erni

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d m

ale

sex

on

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rela

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hip

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een

alco

hol i

ntak

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ence

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arre

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esop

hagu

s80

31O

R:1.

42 1

.23–

1.64

<0.0

001

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Incr

ease

d ag

eM

athe

us D

egio

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(10)

Case

s an

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IS T

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ale

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ar a

nd/o

r Pip

e A

re R

isk

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ors

for B

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tt E

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agus

in M

ale

Patie

nts

With

Gas

troe

soph

agea

l Refl

ux D

isea

se10

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R:1.

06

1.05

-1.0

8 <.

001

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ease

d ag

eA

. Son

nenb

erg(7

)Ca

ses

and

cont

rol

The

influ

ence

of H

elic

obac

ter p

ylor

i on

the

ethn

ic

dist

ribut

ion

of B

arre

tt’s

met

apla

sia

596

479

OR:

18.

29

17.3

9–19

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<0.0

001

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ses

and

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phag

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und

ergo

ing

endo

scop

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ncia

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acto

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year

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troe

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se W

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t Ala

rm

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ptom

s

4122

OR:

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1.

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Age

50 to

59

year

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ery

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n(5)

Coho

rt s

tudy

Low

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vale

nce

of S

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cted

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troe

soph

agea

l Refl

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isea

se W

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t Ala

rm

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ptom

s

4122

OR:

1.54

1.

39 -

1.71

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Age

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ery

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rt s

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vale

nce

of S

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cted

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gus

in G

astr

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phag

eal R

eflux

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ease

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out A

larm

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mpt

oms

4122

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1.

51 -

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Aqua

l to

or

grea

ter t

han

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year

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ery

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n(5)

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rt s

tudy

Low

Pre

vale

nce

of S

uspe

cted

Bar

rett

’s Es

opha

gus

in G

astr

oeso

phag

eal R

eflux

Dis

ease

With

out A

larm

Sy

mpt

oms

4122

OR:

1.42

1.

25 -

1.61

BMI g

reat

er

than

25

Hiro

hiko

Shi

nkai

(15)

Case

s an

d co

ntro

lsA

ssoc

iatio

n be

twee

n th

e Bo

dy M

ass

Inde

x an

d th

e Ri

sk o

f Bar

rett

’s Es

opha

gus

in Ja

pan

113

OR:

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5 1.

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.13

<0.0

1

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th e

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ean

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onne

nber

g(7)

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ntro

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e in

fluen

ce o

f Hel

icob

acte

r pyl

ori o

n th

e et

hnic

di

strib

utio

n of

Bar

rett

’s m

etap

lasi

a59

6 47

9O

R: 1

.14

1.03

–1.2

60.

0117

Pres

enta

tion

and

clin

ical

dat

a (m

edic

al h

isto

ry)

Met

abol

ic

synd

rom

eSh

ou-W

u Le

e(16)

Case

s an

d co

ntro

ls

Ass

ocia

tion

of m

etab

olic

syn

drom

e w

ith e

rosi

ve

esop

hagi

tis a

nd B

arre

tt’s

esop

hagu

s in

a C

hine

se

popu

latio

n77

12O

R:2.

82 2

.05-

3.88

<0.0

01

Met

abol

ic

synd

rom

eCa

dman

L. L

egge

tt(1

7) C

ases

and

co

ntro

lsBE

VS

with

GER

D

Met

abol

ic S

yndr

ome

as a

Ris

k Fa

ctor

for B

arre

tt

Esop

hagu

s: A

Pop

ulat

ion-

Base

d Ca

se-C

ontr

olSt

udy

309

OR:

21.

1-3.

60.

02

Met

abol

ic

synd

rom

eCa

dman

L. L

egge

tt(1

7)

Case

s an

d co

ntro

lsBE

vs

with

out

GER

D

Met

abol

ic S

yndr

ome

as a

Ris

k Fa

ctor

for B

arre

tt

Esop

hagu

s: A

Pop

ulat

ion-

Base

d Ca

se-C

ontr

olSt

udy

309

OR:

1.9

1.03

-3.6

0.04

Cent

ral o

besi

tyCh

ih-C

heng

Che

n(18)

Case

s an

d co

ntro

lsCe

ntra

l Obe

sity

and

H. p

ylor

i Inf

ectio

n In

fluen

ce

Risk

of B

arre

tt’s

Esop

hagu

s in

an

Asi

an P

opul

atio

n16

1O

R:2.

791.

89–4

.12

<0.0

01

Dia

bete

sK.

Key

ashi

an(9

)Ca

ses

and

cont

rols

Barr

ett’s

eso

phag

us in

Lat

inos

und

ergo

ing

endo

scop

y fo

r gas

tres

opha

geal

reflu

x di

seas

e sy

mpt

oms

663

OR:

2.23

1.10

–4.5

30.

03

Hia

tal h

erni

aCa

mill

e Ba

zin(1

9)Ca

ses

and

cont

rols

Esop

hage

al M

otor

Dis

orde

rs A

re a

Str

ong

and

Inde

pend

ant A

ssoc

iate

d Fa

ctor

of B

arre

tt’s

Esop

hagu

s20

1O

R:5.

602.

45-

12.7

6<

0.00

1

Hia

tal h

erni

aA

tsuh

iro M

asud

a(11)

Coho

rt s

tudy

Influ

ence

of h

iata

l her

nia

and

mal

e se

x on

th

e re

latio

nshi

p be

twee

n al

coho

l int

ake

and

occu

rren

ce o

f Bar

rett

’s es

opha

gus

8031

OR:

3.37

2.

50–4

.59

<0.0

001

Page 7: REVIEW ARTICLE RISK FACTORS ASSOCIATED WITH BARRETT'S

Pág. 192

REV

IEW

ART

ICLE

Hia

tal h

erni

aEm

ery

C Li

n(5)

Coho

rt s

tudy

Low

Pre

vale

nce

of S

uspe

cted

Bar

rett

’s Es

opha

gus

in Gas

troe

soph

agea

l Refl

ux D

isea

se W

ithou

t Ala

rm

Sym

ptom

s

4122

OR:

1.60

1.

50 -

1.70

Hia

tal h

erni

aYa

n-H

ua C

hen(6

)Co

hort

stu

dyPr

eval

ence

and

risk

fact

ors

for B

arre

tt’s

esop

hagu

s in

Tai

wan

3385

OR:

3.03

7 1.

765-

5.22

5<

0.00

1

Hia

tal h

erni

aPr

avee

n M

athe

w(2

0)Ca

ses

and

cont

rols

Risk

fact

ors

for B

arre

tt’s

esop

hagu

s in

Indi

an

patie

nts

with

gast

roes

opha

geal

reflu

x di

seas

e27

8O

R:3.

141.

2–8.

170.

01

Hia

tal h

erni

a le

ss th

an 3

cmTh

eres

a H

. Ngu

yen(8

)Ca

ses

and

cont

rols

Risk

Fac

tors

for B

arre

tt’s

Esop

hagu

s Co

mpa

red

Betw

een

Afr

ican

Am

eric

ans

and

Non

-His

pani

c W

hite

s19

52O

R:2.

791.

85–4

.19

<0.0

01

Hia

tal h

erni

a gr

eate

r tha

n or

eq

ual t

o 3c

mTh

eres

a H

. Ngu

yen(8

)Ca

ses

and

cont

rols

Risk

Fac

tors

for B

arre

tt’s

Esop

hagu

s Co

mpa

red

Betw

een

Afr

ican

Am

eric

ans

and

Non

-His

pani

c W

hite

s19

52O

R:5.

083.

35–7

.69

<0.0

01

Hia

tal h

erni

aH

irohi

ko S

hink

ai(1

5)Ca

ses

and

cont

rols

Ass

ocia

tion

betw

een

the

Body

Mas

sIn

dex

and

the

Risk

of B

arre

tt’s

Esop

hagu

sin

Japa

n 11

3O

R:18

.37.

21–4

6.5

<0.0

1

Activ

e ga

triti

s (a

ntru

m)

Ther

esa

H. N

guye

n(8)

Case

s an

d co

ntro

ls

Risk

Fac

tors

for B

arre

tt’s

Esop

hagu

s Co

mpa

red

Betw

een

Afr

ican

Am

eric

ans

and

Non

-His

pani

c W

hite

s19

52O

R:1.

731.

10–2

.73

0.02

Use

of p

roto

n in

hibi

tor p

ump

Ther

esa

H. N

guye

n(8)

Case

s an

d co

ntro

ls

Risk

Fac

tors

for B

arre

tt’s

Esop

hagu

s Co

mpa

red

Betw

een

Afr

ican

Am

eric

ans

and

Non

-His

pani

c W

hite

s19

52O

R:1.

881.

40–2

.52

<0.0

01

Use

of p

roto

n in

hibi

tor p

ump

Hiro

hiko

Shi

nkai

(15)

Case

s an

d co

ntro

ls

Ass

ocia

tion

betw

een

the

Body

Mas

sIn

dex

and

the

Risk

of B

arre

tt’s

Esop

hagu

sin

Japa

n 11

3O

R:8.

28

2.96

–12

3.1

0.01

Pres

ence

of

belc

hing

Prav

een

Mat

hew

(20)

Case

s an

d co

ntro

ls

Risk

fact

ors

for B

arre

tt’s

esop

hagu

s in

Indi

an

patie

nts

with

gast

roes

opha

geal

reflu

x di

seas

e27

8O

R:2.

281.

11–4

.66

0.02

Page 8: REVIEW ARTICLE RISK FACTORS ASSOCIATED WITH BARRETT'S

Pág. 193

REVIEW

ARTIC

LE

Mot

or

diso

rder

of t

he

esop

hagu

sCa

mill

e Ba

zin(1

9)Ca

ses

and

cont

rols

Esop

hage

al M

otor

Dis

orde

rs A

re a

Str

ong

and

Inde

pend

ant A

ssoc

iate

d Fa

ctor

of B

arre

tt’s

Esop

hagu

s20

1O

R:4.

491.

85-

10.9

3<0

.001

Rge

Yous

af B

ashi

r Had

i(4)

Case

s an

d co

ntro

ls

Inde

pend

ent a

ssoc

iatio

n of

obs

truc

tive

slee

p ap

nea

with

Barr

ett’s

eso

phag

us10

91O

R:2.

231.

45–3

.49

0.01

Rge

Cadm

an L

. Leg

gett

(21)

Case

s an

d co

ntro

lsO

bstr

uctiv

e Sl

eep

Apn

ea Is

a R

isk

Fact

or fo

r Ba

rret

t’s E

soph

agus

7482

OR:

3.4

1.9–

6.0

<.00

01

Rge

Jiro

Wat

ari(2

2)Ca

ses

and

cont

rols

(Cas

es v

s w

ithou

t PPI

)

Ass

ocia

tion

betw

een

obes

ity a

nd B

arre

tt’s

esop

hagu

s in

a Ja

pane

se p

opul

atio

n:a

hosp

ital-b

ased

, cro

ss-s

ectio

nal s

tudy

1581

OR:

3.48

1.89

–6.4

1 <0

.000

1

Rge

Jiro

Wat

ari(2

2)Ca

ses

and

cont

rols

(Cas

es v

s PP

I)

Ass

ocia

tion

betw

een

obes

ity a

nd B

arre

tt’s

esop

hagu

s in

a Ja

pane

se p

opul

atio

n:a

hosp

ital-b

ased

, cro

ss-s

ectio

nal s

tudy

1581

OR:

5.67

2.17

–14

.86

0.00

04

Age

of

pres

enta

tion

of

GER

sym

ptom

un

der 3

0 ye

ars

Om

ar B

akr(2

3)

Case

s an

d co

ntro

ls (C

ases

vs

Popu

latio

n)

Gas

troe

soph

agea

l Refl

ux F

requ

ency

, Sev

erity

, Age

of

Ons

et,

Fam

ily H

isto

ry a

nd A

cid

Supp

ress

ive

Ther

apy

Pred

ict B

arre

tt’s

Esop

hagu

s in

a L

arge

Pop

ulat

ion

317

OR:

2.93

1.67

-5.1

5

Age

of

pres

enta

tion

of

GER

sym

ptom

un

der 3

0 ye

ars

Om

ar B

akr(2

3)Ca

ses

and

cont

rols

(Cas

es v

s Pa

tient

s w

ith G

ER)

Gas

troe

soph

agea

l Refl

ux F

requ

ency

, Sev

erity

, Age

of

Ons

et,

Fam

ily H

isto

ry a

nd A

cid

Supp

ress

ive

Ther

apy

Pred

ict B

arre

tt’s

Esop

hagu

s in

a L

arge

Pop

ulat

ion

316

OR:

1.93

1.15

-3.2

2

Nig

httim

e sy

mpt

oms

of

GER

Om

ar B

akr(2

3)Ca

ses

and

cont

rols

(Cas

es v

s Po

pula

tion)

Gas

troe

soph

agea

l Refl

ux F

requ

ency

, Sev

erity

, Age

of

Ons

et,

Fam

ily H

isto

ry a

nd A

cid

Supp

ress

ive

Ther

apy

Pred

ict B

arre

tt’s

Esop

hagu

s in

a L

arge

Pop

ulat

ion

317

OR:

5.40

3.81

-7.7

2

Feel

ing

stuc

kO

mar

Bak

r(23)

Case

s an

d co

ntro

ls (C

ases

vs

Popu

latio

n)

Gas

troe

soph

agea

l Refl

ux F

requ

ency

, Sev

erity

, Age

of

Ons

et,

Fam

ily H

isto

ry a

nd A

cid

Supp

ress

ive

Ther

apy

Pred

ict B

arre

tt’s

Esop

hagu

s in

a L

arge

Pop

ulat

ion

317

OR:

3.00

2.13

-4.2

4

Page 9: REVIEW ARTICLE RISK FACTORS ASSOCIATED WITH BARRETT'S

Pág. 194

REV

IEW

ART

ICLE

Fam

ily h

isto

ry

of G

ERO

mar

Bak

r(23)

Case

s an

d co

ntro

ls (C

ases

vs

Popu

latio

n)

Gas

troe

soph

agea

l Refl

ux F

requ

ency

, Sev

erity

, Age

of

Ons

et,

Fam

ily H

isto

ry a

nd A

cid

Supp

ress

ive

Ther

apy

Pred

ict B

arre

tt’s

Esop

hagu

s in

a L

arge

Pop

ulat

ion

317

OR:

2.55

1.80

-3.6

2

BE fa

mily

hi

stor

yO

mar

Bak

r(23)

Case

s an

d co

ntro

ls (C

ases

vs

Popu

latio

n)

Gas

troe

soph

agea

l Refl

ux F

requ

ency

, Sev

erity

, Age

of

Ons

et,

Fam

ily H

isto

ry a

nd A

cid

Supp

ress

ive

Ther

apy

Pred

ict B

arre

tt’s

Esop

hagu

s in

a L

arge

Pop

ulat

ion

317

OR:

10.0

82.

83-

35.8

4

BE fa

mily

hi

stor

yO

mar

Bak

r(23)

Case

s an

d co

ntro

ls (C

ases

vs

Patie

nts

with

GER

)

Gas

troe

soph

agea

l Refl

ux F

requ

ency

, Sev

erity

, Age

of

Ons

et,

Fam

ily H

isto

ry a

nd A

cid

Supp

ress

ive

Ther

apy

Pred

ict B

arre

tt’s

Esop

hagu

s in

a L

arge

Pop

ulat

ion

316

OR:

3.64

1.50

-8.8

3

1-2

appo

intm

ents

pe

r yea

r for

GER

Om

ar B

akr(2

3)Ca

ses

and

cont

rols

(Cas

es v

s Po

pula

tion)

Gas

troe

soph

agea

l Refl

ux F

requ

ency

, Sev

erity

, Age

of

Ons

et,

Fam

ily H

isto

ry a

nd A

cid

Supp

ress

ive

Ther

apy

Pred

ict B

arre

tt’s

Esop

hagu

s in

a L

arge

Pop

ulat

ion

317

OR:

7.13

4.71

-10

.81

Mor

e th

an 3

ap

poin

tmen

ts

per y

ear f

or G

ERO

mar

Bak

r(23)

Case

s an

d co

ntro

ls (C

ases

vs

Popu

latio

n)

Gas

troe

soph

agea

l Refl

ux F

requ

ency

, Sev

erity

, Age

of

Ons

et,

Fam

ily H

isto

ry a

nd A

cid

Supp

ress

ive

Ther

apy

Pred

ict B

arre

tt’s

Esop

hagu

s in

a L

arge

Pop

ulat

ion

317

OR:

5.12

2.96

-8.8

3

3-5

appo

intm

ents

pe

r yea

r for

any

re

ason

Om

ar B

akr(2

3)Ca

ses

and

cont

rols

(Cas

es v

s Po

pula

tion)

Gas

troe

soph

agea

l Refl

ux F

requ

ency

, Sev

erity

, Age

of

Ons

et,

Fam

ily H

isto

ry a

nd A

cid

Supp

ress

ive

Ther

apy

Pred

ict B

arre

tt’s

Esop

hagu

s in

a L

arge

Pop

ulat

ion

317

OR:

2.06

1.40

-3.0

3

6-10

ap

poin

tmen

ts

per y

ear f

or a

ny

reas

on

Om

ar B

akr(2

3)Ca

ses

and

cont

rols

(Cas

es v

s Po

pula

tion)

Gas

troe

soph

agea

l Refl

ux F

requ

ency

, Sev

erity

, Age

of

Ons

et,

Fam

ily H

isto

ry a

nd A

cid

Supp

ress

ive

Ther

apy

Pred

ict B

arre

tt’s

Esop

hagu

s in

a L

arge

Pop

ulat

ion

317

OR:

2.69

1.65

-4.3

7

Page 10: REVIEW ARTICLE RISK FACTORS ASSOCIATED WITH BARRETT'S

Pág. 195

REVIEW

ARTIC

LE

Mor

e th

an 1

0 vi

sits

per

yea

r fo

r any

reas

onO

mar

Bak

r(23)

Case

s an

d co

ntro

ls (C

ases

vs

Popu

latio

n)

Gas

troe

soph

agea

l Refl

ux F

requ

ency

, Sev

erity

, Age

of

Ons

et,

Fam

ily H

isto

ry a

nd A

cid

Supp

ress

ive

Ther

apy

Pred

ict B

arre

tt’s

Esop

hagu

s in

a L

arge

Pop

ulat

ion

317

OR:

2.25

1.33

-3.8

3

Hum

an

papi

llom

aviru

s D

NA

M. Y

W W

ong(2

4)Ca

ses

and

cont

rols

Hum

an p

apill

omav

irus

expo

sure

and

sex

ual

beha

vior

are

sig

nific

ant r

isk

fact

ors

for B

arre

tt’s

dysp

lasi

a/es

opha

geal

ade

noca

rcin

oma

133

OR:

8.2

2.8–

23.8

0.00

01

Obs

truc

tive

slee

p ap

nea

Yous

af B

ashi

r Had

i(4)

Case

s an

d co

ntro

ls

Inde

pend

ent a

ssoc

iatio

n of

obs

truc

tive

slee

p ap

nea

with

Barr

ett’s

eso

phag

us10

91O

R:3.

261.

72–6

.85

<0.0

1

Obs

truc

tive

slee

p ap

nea

Cadm

an L

. Leg

gett

(21)

Case

s an

d co

ntro

lsO

bstr

uctiv

e Sl

eep

Apn

ea Is

a R

isk

Fact

or fo

r Ba

rret

t’s E

soph

agus

7482

OR:

1.8

1.1–

3.2

0.03

Eros

ive

esop

hagi

tisA

tsuh

iro M

asud

a(11)

Coho

rt s

tudy

Influ

ence

of h

iata

l her

nia

and

mal

e se

x on

th

e re

latio

nshi

p be

twee

n al

coho

l int

ake

and

occu

rren

ce o

f Bar

rett

’s es

opha

gus

8031

OR:

2.82

2.0

4–3.

85<0

.000

1

Eros

ive

esop

hagi

tisH

irohi

ko S

hink

ai(1

5)Ca

ses

and

cont

rols

Ass

ocia

tion

betw

een

the

Body

Mas

sIn

dex

and

the

Risk

of B

arre

tt’s

Esop

hagu

sin

Japa

n 11

315

.33.

49–6

6.8

0.01

Esop

hagi

tisG

loria

Var

gas

Cárd

enas

(14)

Case

s an

d co

ntro

ls

Esóf

ago

de B

arre

tt: P

reva

lenc

ia y

Fac

tore

s de

Ries

go e

n el

Hos

pita

l Nac

iona

l “A

rzob

ispo

Loa

yza”

Lim

a-Pe

rú11

,970

14.8

13.

96-

55.4

10.

001

Gra

de B

es

opha

gitis

(LA

)Em

ery

C Li

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Pág. 196

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ART

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Pág. 197

REVIEW

ARTIC

LE

Life

styl

e (s

exua

l int

erco

urse

, con

sum

ptio

n of

food

and

dri

nk, t

obac

co, a

lcoh

ol)

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on in

a

sexu

al

rela

tions

hip

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W W

ong(2

4)Ca

ses

and

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rols

Hum

an p

apill

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irus

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sure

and

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ual

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vior

are

sig

nific

ant r

isk

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for B

arre

tt’s

dysp

lasi

a/es

opha

geal

ad

enoc

arci

nom

a

133

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1.4–

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e th

an 6

ora

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d co

ntro

ls

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an p

apill

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vior

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isk

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arre

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ohol

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tsuh

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of h

iata

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nia

and

mal

e se

x on

th

e re

latio

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twee

n al

coho

l int

ake

and

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rren

ce o

f Bar

rett

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opha

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o us

ers

vs

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-use

rs)

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eles

s Tob

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and

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re R

isk

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ors

for B

arre

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in M

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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.

DISCUSSIONAccording to the demographic characteristics, for several authors, being a male is a risk factor for Barret's esophagus(4,5,6,7,8,9). Although Matheus Degiovani et al, say that being a female is a risk factor for Barret's esophagus(10).

According to many authors, increased age is a risk factor(4,6,7,9,10,11,12,13,14). 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(16,17).

Other 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 esophagus(5,611,19,20). 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 esophagus.8

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 esophagus(4,21,22). 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(23). Furthermore, 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 esophagus(8,15).

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(11,15). Although for Gloria Vargas Cárdenas et al, only the fact of having esophagitis would already be a risk factor(14), 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.

CONCLUSIONAn 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.

Correspondence: Gerard GomezAddress: Av. Benavides 5440, Santiago de Surco, Lima-Perú.Telephone number: +51 952 831 740E-mail: [email protected]

Authorship contributions: The authors participated in the genesis of the idea, project design, development, collection and interpretation of data, analysis of results, and manuscript preparation.

Financing: Self-financed.

Conflict of interest: The authors declare that they have no conflicts of interest in the publication of this article.

Received: October 1, 2020

Approved: December 04, 2020

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ICLE

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