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Association Between Circulating Levels of Sex Steroid Hormones and Barrett's Esophagus in Men: A Case-Control Analysis.
[esophageal adenocarcinoma]
Esophageal
adenocarcinoma
is
believed
to
result
from
the
progression
of
gastroesophageal
reflux
disease
to
erosive
esophagitis
and
re
-epithelialization
of
the
esophagus
with
a
columnar
cell
population
termed
Barrett
's
esophagus
(
BE
)
.
Men
develop
BE
and
esophageal
adenocarcinoma
more
frequently
than
women
,
and
the
ratio
is
increasing
;
approximately
7
men
are
diagnosed
with
malignancy
for
every
woman
,
yet
little
is
known
about
the
mechanisms
of
this
difference
.
We
assessed
whether
sex
steroid
hormones
were
associated
with
BE
in
a
male
population
.
We
analyzed
data
from
the
Barrett
's
Esophagus
Early
Detection
Case
Control
Study
,
based
at
the
Walter
Reed
National
Military
Medical
Center
.
Blood
samples
were
collected
from
173
men
with
BE
and
213
men
without
BE
(
controls
,
based
on
endoscopic
analysis
)
;
13
sex
steroid
hormones
were
measured
by
mass
spectrometry
and
sex
hormone
binding
globulin
was
measured
by
enzyme-linked
immunosorbent
assay
.
We
also
calculated
free
estradiol
,
free
testosterone
,
and
free
dihydrotestosterone
(
DHT
)
.
We
used
multivariable
logistic
regression
to
estimate
odds
ratios
(
ORs
)
and
95
%
confidence
intervals
(
CIs
)
adjusted
for
age
,
race
,
smoking
status
,
alcohol
consumption
,
body
mass
index
(
in
kg
/
m
(
2
)
)
,
heartburn
,
regurgitation
,
and
gastroesophageal
symptom
score
(
excluding
heartburn
and
regurgitation
)
.
Levels
of
free
testosterone
and
free
DHT
were
associated
positively
with
BE
risk
;
patients
in
the
highest
quartile
for
these
hormones
were
most
likely
to
have
BE
(
free
testosterone
:
OR
,
5
.
36
;
95
%
CI
,
2
.
21
-
13
.
03
;
P
Â
=
.
0002
;
free
DHT
:
OR
,
4
.
25
;
95
%
CI
,
1
.
87
-
9
.
66
;
P
Â
=
.
001
)
.
Level
of
estrone
sulfate
was
associated
inversely
with
BE
risk
(
P
for
trend
Â
=
.
02
)
.
No
other
hormone
was
associated
with
BE
risk
.
Relationships
were
not
modified
by
age
or
BMI
.
In
an
analysis
of
men
,
levels
of
free
testosterone
and
free
DHT
were
associated
significantly
with
risk
of
BE
.
Diseases
Validation
Diseases presenting
"also calculated free estradiol"
symptom
esophageal adenocarcinoma
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