Índices triglicéridos-glucosa como estimadores de insulinorresistencia en personas con riesgo de desarrollar diabetes tipo 2 / Triglyceride-glucose indices as estimators of insulin resistance in people at risk of developing type 2 diabetes

EL HOMA-IR (homeostasis model assessment-insulin-resistance) es un estimador de insulinorresistencia (IR) pero depende de la determinación de insulina. Los índices triglicéridos-glucosa (T-G)-circunferencia de la cintura (CC) (T-G-CC) o triglicéridos-glucosa-índice de masa corporal (TG- IMC) podrían ser sustitutos. Los objetivos de este trabajo consistieron en investigar en personas con riesgo de desarrollar diabetes tipo 2 (DT2): a) los índices T-G, T-G-CC y T-G-IMC como estimadores de HOMA-IR>2,1; b) determinar su poder discriminante. Se realizó un estudio prospectivo en el que se estudiaron 223 individuos ≥45 años con riesgo de desarrollar diabetes tipo 2 (DT2). La relación T-G se calculó como ln [triglicéridos (mg/dL) x glucemia (mg/dL)/2]. La relación T-G-CC y T-G-IMC fue el producto de T-G por CC o IMC. Se utilizó análisis de regresión logística y se calcularon las áreas bajo las curvas ROC (receiver operating characteristic curves) (ABC) para comparar las asociaciones de T-G, T-G-CC y T-G-IMC con HOMA-IR>2,1. Mediante análisis discriminante se evaluó la clasificación de los sujetos entre HOMA-IR>2,1 y HOMA-IR≤2,1. ABC, sensibilidad, especificidad, poder predictivo positivo y negativo para T-G-CC y T-G-IMC fueron mayores que para T-G, con los siguientes valores de corte: T-G=8,75, T-G-CC=821 y T-G-IMC=255. Los odds ratios (OR) para HOMA-IR>2,1, ajustados para confusores, fueron: T-G>8,75, OR: 4,85 (IC 95% 2,73-8,62); T-G-CC>821, OR: 10,41 (IC 95% 5,55-19,53); T-GIMC> 255, OR: 10,41 (IC 95% 5,55-19,53). Con el análisis discriminante T-G>8,75 clasificó correctamente 69,2% individuos con HOMA-IR≤2,1 y 68,3% con HOMA-IR>2,1; T-G-CC y T-G-IMC clasificaron 74,4% y 78,2% respectivamente (p<0,001 en todos los casos). Se concluyó que T-GCC> 821 y T-G-IMC>255 fueron mejores estimadores de HOMA-IR>2,1 que T-G>8,75. Estas son determinaciones simples y accesibles y podrían ser útiles en la práctica clínica y en estudios epidemiológicos.

HOMA-IR ((homeostasis model assessment-insulin-resistance) is a surrogate estimator of insulin resistance (IR) but it depends on insulin determination. Triglyceride-glucose-waist circumference (T-G-WC) or triglyceride-glucose-body mass index (BMI) (T-G-BMI) could be substitutes. The objectives of this work were: to investigate in people at risk of developing type 2 diabetes (T2D): a) T-G, T-G-CC and T-G-BMI as estimators of HOMA-IR>2.1 and b) to determine their discriminating power. A prospective study was conducted studying 223 individuals ≥45 years of age at risk of developing type 2 diabetes (T2D). The T-G ratio was calculated as ln [triglycerides (mg/dL) x glycemia (mg/dL)/2]. The T-G-CC and T-G-BMI ratio was the product of T-G by CC or BMI. Logistic regression analysis was used and the areas under the receiver operating characteristic curves (ROC) curves were calculated to compare the associations of T-G, T-G-CC and T-G-BMI with HOMA-IR>2.1. Using a discriminant analysis, the classification of the subjects between HOMA-IR>2.1 or HOMA-IR≤2.1 was evaluated. AUC, sensitivity, specificity, positive and negative predictive powers for T-G-CC and T-G-BMI were higher than for T-G, with the following cut-off values: TG=8.75, T-G-CC=821 and T-G-BMI=255. Odds ratios (OR) for HOMA-IR>2.1, adjusted for confounders, were: T-G>8.75, OR 4.85 (95% CI 2.73-8.62); T-G-CC>821, OR 10.41 (95% CI 5.55-19.53); T-G-BMI>255, OR 10.41 (95% CI 5.55-19.53). With the discriminant analysis T-G>8.75, 69.2% correctly classified with HOMA-IR≤2.1 and 68.3% with HOMA-IR>2.1; T-G-CC and T-G-BMI correctly classified 74.4% and 78.2% respectively (p <0.001 in all cases). It is concluded that T-G-CC>821 and T-G-BMI>255 were better estimators of HOMA-IR>2.1 than T-G>8.75. T-G-WC and T-G-BMI are simple and reliable determinations and could be useful in clinical practice and epidemiological studies.

O HOMA-IR (homeostasis model assessment-insulin-resistance) e um estimador de resistencia a insulina (RI), mas depende da determinacao da insulina. Triglicerideos-glicose (T-G), circunferencia da cintura (CC) (T-G-CC) ou triglicerideos-glicose-indice de massa corporal (T-G-IMC) poderiam ser substitutos. Os objetivos desse trabalho foram investigar em pessoas com risco de desenvolver diabetes tipo 2 (DT2): a) os indices T-G, T-G-CC e T-G-IMC como estimadores de HOMA-IR> 2,1; b) determinar seu poder discriminante. Um estudo prospectivo foi realizado em 223 pessoas ≥45 anos com risco de desenvolver diabetes tipo 2 (DT2). A razao T-G foi calculada como ln [triglicerideos (mg/dL) x glicemia (mg/dL)/2]. A razao T-G-CC e T-G-IMC foi o produto de T-G por CC ou IMC. A analise de regressao logistica foi utilizada e as areas sob as curvas ROC (receiver operating features) ABC foram calculadas para comparar as associacoes de T-G, T-G-CC e T-G-IMC com HOMA-IR>2.1. Por meio de analise discriminante, avaliou-se a classificacao dos sujeitos entre HOMA-IR>2,1 e HOMA-IR≤2,1. ABC, sensibilidade, especificidade, poder preditivo positivo e negativo para TG-CC e TG-IMC foram maiores que para TG, com os seguintes valores de corte: TG=8,75, TG-CC=821 e TG-IMC=255. Odds Ratios (OR) para HOMA-IR>2,1, ajustados para fatores de confusao, foram: TG>8,75, OR 4,85 (IC95% 2,73-8,62); T-G-CC>821, OR 10,41 (IC 95% 5,55-19,53); T-G-IMC>255, OR 10,41 (IC 95% 5,55-19,53). Com a analise discriminante T-G>8,75, 69,2% foram classificados corretamente com HOMA-IR≤2,1 e 68,3% com HOMA-IR>2,1; T-G-CC e T-G-IMC classificaram 74,4% e 78,2%, respectivamente (p<0,001 em todos os casos). Conclui-se que T-G-CC>821 e TG- IMC>255 foram melhores estimadores de HOMA-IR>2,1 que T-G>8,75. Elas sao determinacoes simples e acessiveis e poderiam ser uteis na pratica clinica e em estudos epidemiologicos.

Relación entre síndrome metabólico e insulino resistencia en adultos con riesgo para diabetes tipo 2 / Relationship between the metabolic syndrome and the insulin resistance in adults with type 2 diabetes risk / Relação entre síndrome metabólica e insulino-resistência em adultos com risco para diabetes tipo 2

La diabetes mellitus tipo 2 (DBT2) es muy frecuente en la población pero no siempre está diagnosticada. Las alteraciones en el metabolismo de la glucosa (Glu) y el síndrome metabólico (SM) se presentan años antes de DMT2. Se realizó un estudio poblacional transversal, aleatorio y estratificado según nivel socioeconómico en 223 sujetos de 45 y más años con riesgo para DMT2. SM se determinó según AHA/NHLBI. El objetivo de este trabajo consistió en: a) Determinar la frecuencia de sujetos con Glu alterada en ayunas y SM; b) Determinar la relación entre diferentes índices de insulino-resistencia (IR), QUICKI, HOMA, Insulina (Ins) e Ins/Glu con SM y sus componentes. Los resultados fueron: la Glu elevada en ayunas (100-125 mg/dL) fue 19,3% (varones 22,1% y mujeres 17,8% (ns)); Glu=126 mg/dL, 2,2%; SM 38,1% (varones 33,8%, mujeres 40,4% (ns)). La IR se asoció con cintura y triglicéridos (p<0,001), C-HDL y presión arterial (p<0,01). Con curvas ROC se hallaron valores de corte de índices de IR para predicción de SM: QUICKI<0,33, HOMA>2,1; Ins>10 mU/L, Ins/Glu>1,8. HOMA-IR>2,1 vs SM mostró: sensibilidad 72,6%, especificidad 70,1%, valor predictivo positivo 60,4%, valor predictivo negativo 80,3%. Por análisis de regresión logística se hallaron predictores de SM: HOMA>2,1, OR = 8,76, (IC95% 4,37-17,55), p<0,001; historia familiar de diabetes, OR=4,74 (IC 95% 2,23-10,05), p≤0,001; bajo nivel de educación formal OR=2,69 (IC 95% 1,33-5,46), p=0,006. Se concluye que la frecuencia de Glu alterada en ayunas no fue mayor que para población general pero SM fue muy frecuente en las mujeres. HOMA-IR >2,1 y QUICKI<0,33 fueron fuertes predictores de SM asociados a aumentos de cintura y triglicéridos. La historia familiar de diabetes y el bajo nivel de educación formal configuraron un perfil fuertemente predictor de SM.

Relación entre síndrome metabólico e insulino resistencia en adultos con riesgo para diabetes tipo 2 / Relationship between the metabolic syndrome and the insulin resistance in adults with type 2 diabetes risk / RelaþÒo entre síndrome metabólica e insulino-resistÛncia em adultos com risco para diabetes tipo 2

La diabetes mellitus tipo 2 (DBT2) es muy frecuente en la población pero no siempre está diagnosticada. Las alteraciones en el metabolismo de la glucosa (Glu) y el síndrome metabólico (SM) se presentan años antes de DMT2. Se realizó un estudio poblacional transversal, aleatorio y estratificado según nivel socioeconómico en 223 sujetos de 45 y más años con riesgo para DMT2. SM se determinó según AHA/NHLBI. El objetivo de este trabajo consistió en: a) Determinar la frecuencia de sujetos con Glu alterada en ayunas y SM; b) Determinar la relación entre diferentes índices de insulino-resistencia (IR), QUICKI, HOMA, Insulina (Ins) e Ins/Glu con SM y sus componentes. Los resultados fueron: la Glu elevada en ayunas (100-125 mg/dL) fue 19,3% (varones 22,1% y mujeres 17,8% (ns)); Glu≥126 mg/dL, 2,2%; SM 38,1% (varones 33,8%, mujeres 40,4% (ns)). La IR se asoció con cintura y triglicéridos (p2,1; Ins>10 mU/L, Ins/Glu>1,8. HOMA-IR>2,1 vs SM mostró: sensibilidad 72,6%, especificidad 70,1%, valor predictivo positivo 60,4%, valor predictivo negativo 80,3%. Por análisis de regresión logística se hallaron predictores de SM: HOMA>2,1, OR = 8,76, (IC95% 4,37-17,55), p2,1 y QUICKI<0,33 fueron fuertes predictores de SM asociados a aumentos de cintura y triglicéridos. La historia familiar de diabetes y el bajo nivel de educación formal configuraron un perfil fuertemente predictor de SM.(AU)

Type 2 diabetes mellitus (T2DM) is very common in the population but not always diagnosed. Alterations in the metabolism of glucose (Glu) and the metabolic syndrome (MS) are presented years before T2DM. A cross-population study, randomized and stratified by socioeconomic level in 223 subjects aged 45 and over at risk for T2DM was performed. SM was determined according to AHA / NHLBI. Objectives: a) to determine the frequency of subjects with impaired fasting Glu and SM; b) to determine the relationship between different indices of insulin resistance (IR), QUICKI, HOMA, insulin (Ins) and Ins/Glu with MS and its components. Results: elevated fasting Glu (100-125 mg/dL) was 19.3% (males 22.1%, women 17.8% (ns)), Glu≥126 mg/dL, 2.2%, SM 38.1% (males 33.8%, women 40.4% (ns)). IR was associated with waist and triglycerides (p 2.1, Ins>10 mU/L, Ins/Glu>1.8. HOMA-IR>2.1 vs MS showed: sensitivity 72.6%, specificity 70.1%, positive predictive value 60.4%, negative predictive value 80.3%. For logistic regression analysis found predictors of MS: HOMA> 2.1, OR=8.76 (95% CI 4.37-17.55), p 2.1 and QUICKI <0.33 were strong predictors of SM associated with increases in waist and triglycerides. Family history of diabetes and low levels of formal education shaped a strong predictor of SM profile.(AU)

A diabetes mellitus tipo 2 (DBT2) é muito frequente na populaþÒo mas nem sempre está diagnosticada. As alteraþ§es no metabolismo da glicose (Glu) e da síndrome metabólica (SM) se apresentam anos antes de DMT2. Foi realizado um estudo populacional transversal, aleatório e estratificado conforme o nível socioecon¶mico em 223 sujeitos de 45 e mais anos com risco para DMT2. A SM foi determinada segundo AHA/NHLBI. O objetivo deste trabalho consistiu em: a) determinar a frequÛncia de sujeitos com Glu alterada em jejum e SM; b) Determinar a relaþÒo entre diferentes índices de insulino-resistÛncia (IR), QUICKI, HOMA, Insulina (Ins) e Ins/Glu com SM e seus componentes. Os resultados foram: Glu elevada em jejum (100-125 mg/dL) foi 19,3% (homens 22,1% e mulheres 17,8% (ns)); Glu≥126 mg/dL, 2,2%; SM 38,1% (homens 33,8%, mulheres 40,4% (ns)). A IR foi associada a cintura e triglicerídeos (p2,1, Ins>10 mU/L, Ins/Glu>1,8. HOMA-IR>2,1 vs. SM mostrou: sensibilidade 72,6%, especificidade 70,1%, valor preditivo positivo 60,4%, valor preditivo negativo 80,3%. Por análise de regressÒo logística foram achados preditores de SM: HOMA>2,1, OR = 8,76, (IC95% 4,37-17,55), p2,1 e QUICKI<0,33 foram fortes preditores de SM associados a aumentos de cintura e triglicerídeos. A história familiar de diabetes e o baixo nível de educaþÒo formal configuraram um perfil fortemente preditor de SM.(AU)

Relación entre síndrome metabólico e insulino resistencia en adultos con riesgo para diabetes tipo 2 / Relationship between the metabolic syndrome and the insulin resistance in adults with type 2 diabetes risk

La diabetes mellitus tipo 2 (DBT2) es muy frecuente en la población pero no siempre está diagnosticada. Las alteraciones en el metabolismo de la glucosa (Glu) y el síndrome metabólico (SM) se presentan años antes de DMT2. Se realizó un estudio poblacional transversal, aleatorio y estratificado según nivel socioeconómico en 223 sujetos de 45 y más años con riesgo para DMT2. SM se determinó según AHA/NHLBI. El objetivo de este trabajo consistió en: a) Determinar la frecuencia de sujetos con Glu alterada en ayunas y SM; b) Determinar la relación entre diferentes índices de insulino-resistencia (IR), QUICKI, HOMA, Insulina (Ins) e Ins/Glu con SM y sus componentes. Los resultados fueron: la Glu elevada en ayunas (100-125 mg/dL) fue 19,3% (varones 22,1% y mujeres 17,8% (ns)); Glu=126 mg/dL, 2,2%; SM 38,1% (varones 33,8%, mujeres 40,4% (ns)). La IR se asoció con cintura y triglicéridos (p<0,001), C-HDL y presión arterial (p<0,01). Con curvas ROC se hallaron valores de corte de índices de IR para predicción de SM: QUICKI<0,33, HOMA>2,1; Ins>10 mU/L, Ins/Glu>1,8. HOMA-IR>2,1 vs SM mostró: sensibilidad 72,6%, especificidad 70,1%, valor predictivo positivo 60,4%, valor predictivo negativo 80,3%. Por análisis de regresión logística se hallaron predictores de SM: HOMA>2,1, OR = 8,76, (IC95% 4,37-17,55), p<0,001; historia familiar de diabetes, OR=4,74 (IC 95% 2,23-10,05), p≤0,001; bajo nivel de educación formal OR=2,69 (IC 95% 1,33-5,46), p=0,006. Se concluye que la frecuencia de Glu alterada en ayunas no fue mayor que para población general pero SM fue muy frecuente en las mujeres. HOMA-IR >2,1 y QUICKI<0,33 fueron fuertes predictores de SM asociados a aumentos de cintura y triglicéridos. La historia familiar de diabetes y el bajo nivel de educación formal configuraron un perfil fuertemente predictor de SM.(AU)

History of negative colorectal endoscopy and risk of rectosigmoid neoplasms at screening flexible sigmoidoscopy.

BACKGROUND AND AIMS: Screening sigmoidoscopy can reduce incidence of colorectal cancer and mortality. The optimal re-screening interval has not yet been defined. This study is aimed at estimating the risk of distal advanced adenomas (diameter >/=10 mm, villous component >20%, high-grade dysplasia) and cancer at screening flexible sigmoidoscopy in subjects aged 55-64 years who reported pre-screening negative colorectal endoscopy. PATIENTS: Eight thousands two hundred two subjects aged 55-64 years who underwent screening flexible sigmoidoscopy within the SCORE trial in Italy and who were able to report their previous history of colorectal endoscopy. RESULTS: Eight hundred eighty three of 8,202 subjects (10.8%) reported at least one prescreening negative endoscopy: among them, after 3-5 years, 6-10 years and >10 years intervals between last reported examination and screening endoscopy, the Absolute Risk of advanced adenomas was 1.5%, 0.9% and 0.9%; one cancer was detected (0.1%). Among the 7,319 subjects who did not report prescreening endoscopy the risks of advanced adenoma and cancer were 3.2% and 0.4%, respectively. Subjects with a previous colorectal examination had a 65% decreased risk of advanced adenomas (OR=0.35, 95%CI 0.18-0.66) and a 71% decreased risk of cancer (OR=0.29, 95%CI 0.04-1.12) as compared to those who did not. For subjects without family history of colorectal cancer the statistically significant decrease of the risk persisted up to ten years. The observed benefit seems not to apply to subjects with family history of colorectal cancer. CONCLUSIONS: Our results are consistent with the hypothesis that the interval between screening sigmoidoscopies could be safely expanded beyond 5 years for subjects without specific risk factors for colorectal cancer.

Randomized trial of different screening strategies for colorectal cancer: patient response and detection rates.

BACKGROUND: Although there is general consensus concerning the efficacy of colorectal cancer screening, there is a lack of agreement about which routine screening strategy should be adopted. We compared the participation and detection rates achievable through different strategies of colorectal cancer screening. METHODS: From November 1999 through June 2001 we conducted a multicenter, randomized trial in Italy among a sample of 55-64 year olds in the general population who had an average risk of colorectal cancer. People with previous colorectal cancer, adenomas, inflammatory bowel disease, a recent (< or =2 years) colorectal endoscopy or fecal occult blood test (FOBT), or two first-degree relatives with colorectal cancer were excluded. Eligible subjects were randomly assigned, within the roster of their general practitioner, to 1) biennial FOBT (delivered by mail), 2) biennial FOBT (delivered by general practitioner or a screening facility), 3) patient's choice of FOBT or "once-only" sigmoidoscopy, 4) "once-only" sigmoidoscopy, or 5) sigmoidoscopy followed by biennial FOBT. An immunologic FOBT was used. Participation and detection rates of the strategies tested were compared using multivariable logistic regression models that adjusted for age, sex, and screening center. All statistical tests were two-sided. RESULTS: Of 28 319 people sampled, 1637 were excluded and 26 682 were randomly assigned to a screening arm. After excluding undelivered letters (n = 427), the participation rates for groups 1, 2, 3, 4, and 5 were 30.1% (682/2266), 28.1% (1654/5893), 27.1% (970/3579), 28.1% (1026/3650), and 28.1% (3049/10 867), respectively. Of the 2858 subjects screened by FOBT, 122 (4.3%) had a positive test result, 10 (3.5 per 1000) had colorectal cancer, and 39 (1.4%) had an advanced adenoma. Among the 4466 subjects screened by sigmoidoscopy, 341 (7.6%) were referred for colonoscopy, 18 (4 per 1000) had colorectal cancer, and 229 (5.1%) harbored an advanced adenoma. CONCLUSIONS: The participation rates were similar for sigmoidoscopy and FOBT. The detection rate for advanced neoplasia was three times higher following screening by sigmoidoscopy than by FOBT.

Long-term endoscopic surveillance of patients with Barrett's esophagus. Incidence of dysplasia and adenocarcinoma: a prospective study.

OBJECTIVE: Barrett's esophagus (BE) is a premalignant condition for which regular endoscopic follow-up is usually advised. We evaluated the incidence of esophageal adenocarcinoma (AC) in patients with BE and the impact of endoscopic surveillance on mortality from AC. METHODS: A cohort of newly diagnosed BE patients was studied prospectively. Endoscopic and histological surveillance was recommended every 2 yr. Follow-up status was determined from hospital and registry office records and telephone calls to the patients. RESULTS: From 1987 to 1997, BE was diagnosed in 177 patients. We excluded three with high-grade dysplasia (HGD) at the time of enrollment. Follow-up was complete in 166 patients (135 male, 31 female). The mean length of endoscopic follow-up was 5.5 yr (range 0.5-13.3). Low-grade dysplasia (LGD) was present initially in 16 patients (9.6%) and found during follow-up in another 24 patients. However, in 75% of cases, LGD was not confirmed on later biopsies. HGD was found during surveillance in three patients (1.8%), one with simultaneous AC; two with HGD developed AC later. AC was detected in five male patients during surveillance. The incidence of AC was 1/220 (5/1100) patient-years of total follow-up, or 1/183.6 (5/918) patient-years in subjects undergoing endoscopy. Four AC patients died, and one was alive with advanced-stage tumor. The mean number of endoscopies performed for surveillance, rather than for symptoms, was 2.4 (range 1-10) per patient. During the follow-up years the cohort had a total of 528 examinations and more than 4000 biopsies. CONCLUSIONS: The incidence of AC in BE is low, confirming recent data from the literature reporting an overestimation of cancer risk in these patients. In our patient cohort, surveillance involved a large expenditure of effort but did not prevent any cancer deaths. The benefit of surveillance remains uncertain.

Baseline findings of the Italian multicenter randomized controlled trial of "once-only sigmoidoscopy"--SCORE.

BACKGROUND: A single sigmoidoscopy examination at around age 60 years has been proposed as a cost-effective strategy to prevent colorectal cancer. A multicenter randomized controlled trial, the SCORE trial, is in progress in Italy to estimate the impact of this strategy on colorectal cancer incidence and mortality and the duration of the protective effect. We present the baseline screening outcomes. METHODS: A questionnaire was mailed to a random sample of 236 568 people aged 55-64 years to assess their eligibility for and interest in screening. Those reporting a history of colorectal cancer, adenomas, inflammatory bowel disease, recent colorectal endoscopy, or two first-degree relatives with colorectal cancer were excluded. Eligible, interested respondents were assigned randomly to the control group (no further contact) or the intervention group (invitation to undergo sigmoidoscopy). Screenees with colorectal cancer, polyps larger than 5 mm, three or more adenomas, adenomas 5 mm or smaller with a villous component of more than 20%, or severe dysplasia were referred for colonoscopy. RESULTS: Of the 56 532 respondents (23.9% of those invited), 34 292 were enrolled and 17 148 were assigned to the screening group. Of those, 9999 attended and 9911 were actually examined by sigmoidoscopy. Distal adenomas were detected in 1070 subjects (10.8%). Proximal adenomas were detected in 116 of 747 (15.5%) subjects without cancer at sigmoidoscopy who then underwent colonoscopy. A total of 54 subjects was found to have colorectal cancer, a rate of 5.4 per 1000 (54% of which were Dukes' A). The procedures were relatively safe, with two perforations (one in 9911 sigmoidoscopy exams and one in 775 colonoscopies) and one hemorrhage requiring hospitalization after polypectomy during colonoscopy. The pain associated with sigmoidoscopy was described as mild or less than expected by 83.3% of the screenees. CONCLUSION: Sigmoidoscopy screening is generally acceptable to recipients and safe. The high yield of advanced adenomas is consistent with the projected impact of sigmoidoscopy screening on colorectal cancer incidence.

Risk factors for Barrett's esophagus: a case-control study.

Barrett's esophagus (BE) is an acquired disorder due to chronic gastroesophageal reflux. Environmental factors seem to play an important role in the pathogenesis of BE, especially in Western society. A multicenter case-control study was carried out between February 1995 and April 1999 in 8 Italian Departments of Gastroenterology gathered in a study group (GOSPE), in order to analyze the influence of some individual characteristics and life-style habits on the occurrence of BE. Three groups of patients were studied: 149 patients with BE, 143 patients with esophagitis (E) and 308 hospital controls (C) with acute, non-neoplastic, non-gastroenterological conditions. The diagnosis of BE was based on endoscopy and histology. E was defined by the Savary classification (grade I-III). Data collection was performed by using a questionnaire that focused on smoking, coffee and alcohol consumption, medical history, drugs history, gastroesophageal reflux disease (GERD) symptoms (heartburn, regurgitation) and socio-economic status. Multivariate analysis showed that the frequency of weekly GERD symptoms was significantly associated with both BE and E (p<0.0001), such as the presence of hiatal hernia (p< or =0.001). Ulcer was significantly associated with BE (p=0.001). Among patients with E, the risk was directly related to spirits consumption (p=0.03). Patients with GERD symptoms that lasted more than 13 years were more likely to have BE than E (p=0.01). In conclusion, results from our study point out that long-standing GERD symptoms, hiatal hernia and possibly alcohol consumption are risk factors in the development of the BE and E.