A predictive model for length of Barrett's esophagus with hiatal hernia length and duration of esophageal acid exposure

BACKGROUND: A significant correlation between the duration and height of esophageal acid exposure and the length of Barrett's mucosa has been demonstrated. The aims of this study were to determine if there is a correlation between hiatal hernia length and Barrett's esophagus length, and to develop a predictive model for Barrett's esophagus length by using hiatal hernia length and duration of esophageal acid exposure. METHODS: Consecutive patients with Barrett's esophagus diagnosed endoscopically were enrolled in the study. Barrett's esophagus was defined by the presence of intestinal metaplasia in biopsy specimens obtained from salmon-colored mucosa extending into the esophagus. Barrett's mucosa 3 cm or greater in length was considered long-segment Barrett's esophagus; and less than 3 cm long was considered short-segment Barrett's esophagus. Hiatal hernia was considered present if the esophagogastric junction was displaced 1 cm or more proximal to the diaphragmatic hiatus. RESULTS: Twenty-four men (mean age 66.1 +/-2.4 [SE]) with Barrett's esophagus were included in this study. Mean Barrett's length was 4.1 +/-0.7 cm. The Pearson correlation coefficient between hiatal hernia length and Barrett's esophagus length was 0.62 (p < 0.01). Similarly, there was a significant correlation between esophageal acid exposure and Barrett's length (r = 0.62; p < 0.01). Multiple linear regression analysis revealed that hiatal hernia length and duration of esophageal acid exposure were associated significantly with length of Barrett's mucosa (R(2) = 0.54; p < 0.001). A regression equation was developed expressing mean Barrett's length (cm) = 0.79 + (0.68) hernia length (cm) + (0.075) duration of esophageal acid exposure (% time pH < 4). CONCLUSIONS: The length of Barrett's mucosa correlated with the length of hiatal hernia. A predictive model for Barrett's length by using hiatal hernia length and duration of esophageal acid exposure was developed. This suggested that these two pathophysiologic factors are good predictors of the length of Barrett's mucosa.