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Gastrointest Endosc. 2006 Apr;63(4):581-6.

Colorectal neoplasia in veterans is associated with Barrett's esophagus but not with proton-pump inhibitor or aspirin/NSAID use.

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1
Departments of Gastroenterology and Hepatology and Public Health, Erasmus MC-University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands.

Abstract

BACKGROUND:

It has been suggested that Barrett's esophagus (BE) is associated with an increased risk of developing colorectal neoplasia, but this has not been reported consistently.

AIM:

To study whether BE is associated with an increased risk of colorectal neoplasia, and if it is, whether it is dependent on use of proton-pump inhibitors (PPIs) or aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).

DESIGN:

Case-control study.

SETTING:

Endoscopic database of the Palo Alto Veterans Affairs Health Care System.

POPULATION:

268 veterans with BE were matched with 268 controls without BE.

INTERVENTION:

Controls had undergone upper GI endoscopy within 14 days of the corresponding case. Colonoscopy was performed within 6 months in cases and controls.

MAIN OUTCOME MEASURE:

Development of colorectal neoplasia.

RESULTS:

Colorectal neoplasia was present in 162 of 268 (60%) BE patients and in 105 of 268 (40%) controls (p < 0.001). The presence of BE (odds ratio [OR] 2.02: 95% CI [1.35, 3.04]), but also increasing age (OR 1.24 per decade: 95% CI [1.04, 1.48]) and alcohol use (OR 1.70: 95% CI [1.16, 2.50]) were associated with an increased risk of colorectal neoplasia in multivariable logistic regression analysis, whereas PPIs (OR 0.99: 95% CI [0.66, 1.48]) and aspirin/NSAIDs (OR 0.90: 95% CI [0.61, 1.33]) had no meaningful effect.

LIMITATIONS:

This was a retrospective study in mostly male veterans.

CONCLUSIONS:

Veterans with BE are at an increased risk of developing colorectal neoplasia. This association is independent from the use of PPIs or aspirin/NSAIDs.

PMID:
16564855
DOI:
10.1016/j.gie.2005.08.043
[Indexed for MEDLINE]
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