Risk factors for Barrett's esophagus compared between African Americans and non-Hispanic Whites.

OBJECTIVES: Esophageal adenocarcinoma is more common among non-Hispanic Whites (NHWs) than African Americans (AAs). It is unclear whether its precursor, Barrett's esophagus (BE), is also less common among AAs, and whether differences in risk factor profiles explain the racial disparity. METHODS: Data were from a case-control study among eligible Veterans Affairs patients scheduled for an upper endoscopy, and a sample identified from primary care clinics. Participants completed a questionnaire on sociodemographic and clinical factors and underwent a study esophagogastroduodenoscopy. We calculated race-specific BE prevalence rates and used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for BE. RESULTS: There were 301 BE cases and 1,651 controls. BE prevalence was significantly higher among NHWs than AAs (21.3 vs. 5.0%; P<0.001). NHWs were more likely than AAs to be male, have a high waist-to-hip ratio (WHR), hiatal hernia, and use proton-pump inhibitors (PPIs), but less likely to have Helicobacter pylori (P<0.001). Among cases, NHWs were more likely to have long-segment BE and dysplasia than AAs. Independent BE risk factors for AAs included a hiatus hernia ≥3 cm (OR 4.12; 95% CI, 1.57-10.81) and a history of gastroesophageal reflux disease or PPI use (OR, 3.70; 95% CI, 1.40-9.78), whereas high WHR (OR, 2.82; 95% CI, 1.41-5.63), hiatus hernia ≥3 cm (OR, 4.95; 95% CI, 3.05-8.03), PPI use (OR, 1.88; 95% CI, 1.33-2.66), and H. pylori (OR, 0.64; 95% CI, 0.41-0.99) were statistically significantly associated with BE risk for NHWs. Among all cases and controls, race was a risk factor for BE, independent of other BE risk factors (OR for AAs, 0.26; 95% CI, 0.17-0.38). CONCLUSIONS: Among veterans, the prevalence of BE was lower in AAs compared with NHWs. This disparity was not accounted for by differences in risk estimates or prevalence of risk factors between NHWs and AAs.

Twenty-five-year survival of children with birth defects in New York State: a population-based study.

BACKGROUND: Few studies have been conducted on long-term survival of children with major birth defects because of a lack of longitudinal birth defects surveillance data. The objective of this study was to conduct a 25-year survival analysis among children in New York born with major defects by survival age, birth defect category, and other possible contributing factors. METHODS: A cohort was constructed containing children born in 1983 to 2006 with selected major birth defects. Deaths among the study cohort were identified by matching the children to their death certificates. The survival probability was estimated by Kaplan-Meier methods. Cox proportional hazards regression was used to examine the effect of the risk factors on survival. RESULTS: A total of 9112 deaths were identified among 57,002 live births with selected birth defects between 1983 and 2006. The overall 25-year survival probability of the study cohort was 82.51% (95% confidence interval, 82.11-82.89%). The estimated survival probability was comparable to that reported from previous studies regarding individual defects including spina bifida, encephalocele, atrioventricular septal defects, tracheoesophageal fistula and esophageal atresia or stenosis, renal agenesis or dysgenesis, lower limb reduction, diaphragmatic hernia, abdominal wall defects, and Down syndrome. Sex, low birth weight for gestational age, existence of multiple birth defects (nonisolated), and maternal age and nativity were identified as risk factors. CONCLUSION: Using the statewide, population-based birth defects surveillance data in New York State, the survival experience of the study cohort was examined across all survival time periods by individual birth defect of interest. Several risk factors that affect survival were identified.

Helicobacter pylori infection and reflux esophagitis in young and middle-aged Japanese subjects.

BACKGROUND AND AIMS: Helicobacter pylori infection rates are reported to be high in people over the age of 40 years, but are decreasing in younger age groups. A negative correlation has been reported between H. pylori infection and reflux esophagitis (RE). METHODS: The subjects were 418 patients who underwent esophagogastroduodenoscopy and measurement of serum immunoglobulin G H. pylori antibodies examined as part of their routine health checks. Their mean age was 39.2 +/- 8.3 years (range 22-58). We analyzed the RE findings (Los Angeles classification: A, B, C, D). RESULTS: The total H. pylori infection rate was 33.7% (141/418). By age group, infection rates were 15.7% in the 20-29 years group, 28.0% in the 30-39 group, 34.3% in the 40-49 group and 69.1% in the 50-59 group. The proportion of H. pylori-negative subjects with RE was 23.5% (20-29, 22.9%; 30-39, 31.7%; 40-49, 32.4%; 50-59, 41.7%), significantly higher than that (12.1%) in H. pylori-positive subjects (20-29, 0%; 30-39, 16.7%; 40-49, 12.2%; 50-59, 10.5%). The severity of RE increased with advancing age in H. pylori-positive subjects, but not in H. pylori-negative subjects. CONCLUSION: In this study, higher rates of RE were seen in H. pylori-negative subjects. It may be, however, that the presence of H. pylori infection influences the progression of RE.

Systematic review: geographical and ethnic differences in gastro-oesophageal reflux disease.

BACKGROUND: Many observers believe that gastro-oesophageal reflux disease is more common among white individuals compared with Asians and Afro-Caribbean subjects. AIM: To perform a systematic review regarding geographical and ethnic factors in the prevalence of reflux symptoms, endoscopic oesophagitis, hiatus hernia and Barrett's oesophagus. RESULTS: Differences in definitions and methodology make comparison between studies difficult. Overall, however, the community prevalence of reflux symptoms, as well as the prevalence of endoscopic oesophagitis, hiatus hernia and Barrett's oesophagus among patients undergoing upper endoscopy, were lower among Asian and Afro-Caribbean subjects compared with white individuals. There may also be a north-south gradient in the prevalence of gastro-oesophageal reflux disease among western countries. Gastro-oesophageal reflux disease may be moderately common in the Middle East. There are suggestions that the prevalence of gastro-oesophageal reflux disease is increasing in the Far East. CONCLUSIONS: More data are required, especially from Africa, South America, the Middle East, and the Indian subcontinent. Suggestions are made regarding definitions and methodology to facilitate comparison between future studies from different countries.

Different prevalences of reflux oesophagitis and hiatus hernia among dyspeptic patients in England and Singapore.

OBJECTIVE: To compare the frequency of reflux oesophagitis and hiatus hernia in dyspeptic patients in England with that in Singapore. DESIGN: Demographic, clinical and endoscopic findings in consecutive dyspeptic patients seen in England and Singapore by the same clinician were compared. The association of various factors with the occurrence of hiatus hernia and oesophagitis was analysed by logistic regression. SETTING: District general hospital in England and university hospital in Singapore. PARTICIPANTS: The English series comprised 212 consecutive patients, and 173 patients were seen in Singapore. RESULTS: Reflux oesophagitis and hiatus hernia were found in 52 (25%) and 50 (49%) of the English patients, and 12 (6%) and 7 (4%) of the Singapore patients, respectively (P<0.005 in each case). Race, body mass index and age were independently associated with hiatus hernia (odds ratios 3.07, 1.08 and 1.04, respectively). The risk factors for oesophagitis were race, sex, body mass index and age (odds ratios 4.04, 2.37, 1.11 and 1.02, respectively). If hiatus hernia was included in the analysis, the risk factors were hiatus hernia, sex, race and body mass index (odds ratios 20.10, 3.07, 2.81 and 1.09, respectively). CONCLUSIONS: Reflux oesophagitis and hiatus hernia are more common in English dyspeptic patients compared to those in Singapore. The most important risk factor for both oesophagitis and hiatus hernia is race.

Gastrointestinal disease amongst Polish migrants in Nottingham.

The main Polish migrations to Britain were in the 1940s and many families have retained a traditional diet. People of Polish origin living in Nottingham were interviewed and the frequency of gastrointestinal disease assessed. Gallstones were less common in English people and Polish migrants than in Poland. Appendicitis and haemorrhoids were commoner in Polish migrants that amongst people in Poland.