Etiological difference between ultrashort- and short-segment Barrett’s esophagus
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Barrett’s esophagus has been divided into three categories based on the extent of the metaplasia: long-segment (LSBE), short-segment (SSBE), and ultrashort-segment Barrett’s esophagus (USBE). While both LSBE and SSBE are thought to be induced by gastroesophageal reflux, the etiology of USBE is still unclear.
We conducted a case–control study to identify the differences in the pathogenesis between SSBE and USBE in a hospital-based population. The endoscopic findings and clinical factors of 199 patients with short-segment endoscopically suspected esophageal metaplasia (SS-ESEM) and 317 patients with ultrashort-segment ESEM (US-ESEM) were compared with those of 199 and 317 age- and gender-matched patients without ESEM.
The severity of gastric mucosal atrophy was marginally associated with the presence of US-ESEM [odds ratio (OR) 1.20, 95% confidence interval (CI) 0.98–1.46, p = 0.08], but not with that of SS-ESEM. On the other hand, the presence of gallstones and that of severe reflux esophagitis were associated with the presence of SS-ESEM (OR 2.19, 95% CI 1.21–3.98; OR 1.72, 95% CI 1.08–2.75), but not with that of US-ESEM. Presence of gastric corpus atrophy without gallstones was associated with the presence of US-ESEM, but not with that of SS-ESEM.
Presence of gastric corpus atrophy was associated with an increased likelihood of the presence of US-ESEM, whereas the presence of gallstones was associated with an increased likelihood of the presence of SS-ESEM, suggesting difference in etiology between US- and SS-ESEM.
KeywordsShort-segment Barrett’s esophagus Gastric corpus atrophy Gallstone
This study was supported by the Graduate School Doctoral Student Aid Program, Keio University (to J.M.), a Grant-in-Aid for Scientific Research (B) from the Japan Society for the Promotion of Science (22300169, to H.S.), a grant from the Smoking Research Foundation (to H.S.), Keio Gijuku Academic Development Funds (to H.S.).