1. Epidemiology and Risk Factors for Barrett’s Esophagus and Esophageal Adenocarcinoma Amitabh Chak, MD University Hospitals Case Medical Center Cleveland, OH

2. Pohl, H. et al. J Natl Cancer Inst 2005;97:142-146 EAC melanoma prostate breast/lung colon

3. Bytzer et al. AJG 1999

6. Progression (histology, courtesy of JHU website) BE LGD HGD CA (1.5 – 4 yrs) (0.5 – 1.5 yrs)

7. Prevalence of BE

9. Age of Cancer Diagnosis Chak et al., AJG 2009 - MEAN AGE = 62 years

10. Age Prevalence of BE (Cameron, et al.)

11. Men:Women Ratio in EAC and BE Country (N) Disease M:W Gammon et al., JNCI, 1992 USA 293 EAC 5:1 Byzer et al., AJG 1999 Denmark 524 EAC 4:1 Lagergren, et al. NEJM 1999 Sweden 189 EAC 6.7:1 Caygill et al., AJG 2002 UK 507 BE 1.7:1 Conio et al., IJC, 2002 Italy 149 BE 3:1 Rex, et al., Gastro 2003 USA 65 BE 2.6:1

13. Chronic GERD and EAC (Lagergren, et al. NEJM 1999) Multivariate adjustment for age. Sex, BMI, smoking, etc.

14. Frequency, Severity, and Duration

15. GERD and BE (Conio M, et al., Int J Cancer 2002) Eight Centers from Italy. Case control study . Odds Ratios Adjusted for Age, gender, and center

16. GERD Symptoms and BE (Eisen et al., AJG 1997) Case Control Study of 79 pts with BE and 180 controls

17. Symptom Duration and BE P < 0.05 for difference in duration and difference in age Of onset of symptoms

18. Symptom Duration and BE (Lieberman et al., AJG 1997) GORGE Dtaabase of endoscopic procedures in Portland, OR

19. Obesity Increases Risk of GERD (Corley et al. 2007)

20. Lagergren et al. 1999 (Association of Obesity is Independent of GERD) ODDS RATIO Body Mass Index

21. Meta-Analysis of Obesity and EAC (Corley et al., CEBP 2006) Excluded the Lagergren study because of heterogeneity

22. AGE IN YEARS OBESE NON-OBESE

23. Association of BE with Abdominal Obesity (Corley et al., Gastro 2007) 320 BE Cases and 317 Population Controls OR = 2.24 (1.21-4.15) for Waist > 80 vs. waist < 80, p = 0.08 for trend

24. Association of BE with Abdominal Obesity (Vaughan et al., Gastro 2007) 193 community cases and 211 matched population controls Odds ratios of BMI and WHR adjusted for each other in LSBE patients

25. Association of High WHR Independent of GERD (Vaughan et al.)

26. Smoking/EtOH and EAC (Brown et al., Cancer Causes Ctl, 1994)

27. Smoking/EtOH and EAC (Gammon et al., JNCI 1997)

28. Smoking/EtOH and BE (Conio et al.)

29. ASA/NSAIDs and EAC (Corley et al., Gastro 2003)

30. LES Lowering Meds and EAC (Lagergren, et al. AIM 2000)

31. H. Pylori and BE/EAC (Weston et al., AJG 2000)

32. Strain Specific H. pylori (Vaezi et al., AJG 2000)