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sp,0.001), and higher intolerability (median score 1 vs. 1, p ,0.001). The Z-line was fullyvisualized in 58/69 (84%) who completed TNE and 8 subjects with ZAP grade II or higherwere referred for sedated EGD. The Z-line was fully visualized in 67/72 (93%) who completedECE and 3 subjects with ZAP grade II or higher were referred for EGD. BE was confirmedby biopsy in 2/69 (2.8%) TNE subjects and 2/72 (2.7 %) ECE subjects. BE was present in4/69 (5.8%) white and 0/76 (0%) African American subjects. Conclusions: Both TNE andECE were feasible in the clinic setting and helped identify BE overall in 2.8% of this VApopulation. Screening was effective only in whites and had no yield in African Americans.Given the nearly equal acceptability and yield, cost considerations and availability of equip-ment and personnel should guide which non-invasive modality should be utilized for BEscreening. Supported by an ARRA grant and BETRNet.

Mo1905

Has There Been a Change in the Prevalence of Be or Patient CharacteristicsThat May Be Contributing to the Increasing EAC Incidence?Vijay Kanakadandi, Maria Giacchino, Srinivas Gaddam, Ajay Bansal, Amit Rastogi, AprilD. Higbee, Neil Gupta, Prateek Sharma

Background: The incidence of esophageal adenocarcinoma (EAC) has increased six fold overthe last few decades. It would be important to ascertain if there has been a change in theprevalence of BE (i.e. increase) or patient characteristics (i.e. increasing BE length, morehiatus hernia, increasing BMI etc) that may be contributing to the increasing EAC incidence.Aim: To evaluate for changes in the prevalence and characteristics of patients with newlydiagnosed BE over the last 15 years in a large multicenter cohort. Methods: Patients presentingto the endoscopy unit for their index endoscopy for evaluation of GERD symptoms wereenrolled in this prospective cohort study. Patients were asked to complete a validated GERDquestionnaire (GERQ) that documents the onset of GERD symptoms (heartburn and acidregurgitation) and grades the frequency and severity of symptoms experienced over the pastyear. Demographic information such as body mass index (BMI), smoking history, use ofPPIs and aspirin/NSAIDs were recorded. Endoscopic details including length of BE, presenceand size of hiatal hernia (HH) were recorded. Patients were divided into 5 groups dependingon the time of index endoscopy- those presenting before 2001, 2001-2003, 2004-2006,2007-2009 and 2010 to date. Age, BMI, smoking status, prevalence and size of hiatal hernia(HH), prevalence and size of BE were calculated for each of those groups. Logistic regressionanalysis was used to calculate the p-value for trend. Results: Of a total of 1097 consecutiveGERD patients presenting for their index EGD, 1024 were male (93.3%), 910 (83.6%) wereCaucasian, and 850 (78.2%) were smokers. The overall prevalence of BE was 15.5 %, themean length of BE (SD) was 1.99 (2.5) cm, the mean BMI was 29.7 (5.7) kg/m2and meanage at presentation was 57.1 (12.7) years. There was no statistically significant trend (eitherincrease or decrease) in the prevalence of BE among these GERD patients on their indexendoscopy and remained stable over time (Table). Similarly, there was no significant differ-ence in BE patient characteristics (age, gender, BE length) and potential risk factors associatedwith BE (smoking, BMI ,presence and size of hiatal hernia) over the past 15 years. A gradualincrease in the use of PPI use was noted during the time period. Conclusions: In a largeprospective cohort of GERD patients, the prevalence of BE at index endoscopy , BE patientcharacteristics (age, gender, BE length) and risk factors associated with BE (smoking, BMI,hiatal hernia) have remained stable over the last 15 years. Additional factors should beevaluated in order to explain the increasing incidence of EAC.Time Trend Analysis for Characteristics of BE

Mo1906

Obstructive Sleep Apnea Is a Risk Factor for Barrett's EsophagusCadman L. Leggett, Emmanuel C. Gorospe, Andrew D. Calvin, William S. Harmsen, AlanR. Zinsmeister, Sean Caples, Virend K. Somers, Kenneth K. Wang, Lori S. Lutzke, PrasadG. Iyer

Background: Patients with obstructive sleep apnea (OSA) and Barrett's esophagus (BE) sharecommon risk factors including central obesity and gastroesophageal reflux (GER) symptoms.It is unclear if OSA increases the risk of BE independent of reflux and BMI. Aim: To examinewhether OSA is associated with an increased risk of BE using a clinic-based case controlstudy. Methods: We searched the clinic database of a large, academic, integrated healthcaresystem from Jan. 2000 to Nov. 2011 and identified patients who had undergone both aformal polysomnogram and an upper endoscopy. Participants were subdivided into fourgroups by the presence (+) or absence (-) of a diagnosis of BE and OSA (-BE/-OSA, +BE/-OSA, -BE/+OSA, +BE/+OSA) and randomly matched in a 1:2 ratio on age, gender and BMI.BE was diagnosed based on endoscopic identification of columnar epithelium and histologicalevidence of intestinal metaplasia confirmed by an expert gastrointestinal pathologist. Presenceand severity of esophagitis was recorded as well as history of GER and use of acid-suppressionmedications. The diagnosis and severity of OSA was confirmed by the apnea-hypopneaindex (AHI) and SleepMedicine evaluation record. Univariate andmultiple variable regressionmodels were used to assess the association between BE and OSA. Results: 264 patients wereincluded in the study of which 36 were identified as (+BE/-OSA), 74 as (-BE/-OSA), 74 as

S-690AGA Abstracts

(+BE/+OSA) and 78 as (-BE/+OSA). There was no significant association of the +BE/+OSAgroup with baseline characteristics (age, gender, race, BMI and smoking history) (table 1).The overall mean (SD) age was 61(13), 72% were males, 99% were Caucasian. A total of172(66%) patients had a history of tobacco use. In patients with BE the mean segmentlength was 3(2.6) cm. Overall, 137(52%) patients had a hiatal hernia with a mean lengthof 3.10 cm. In the 110 patients with BE, 74 had no dysplasia, 24 had low-grade dysplasia,8 had high-grade dysplasia and 4 had cancer. Patients with OSA had a mean AHI score of24.7(21.9) of which 89 (59%) had moderate to severe OSA (AHI>20). 148(56%) patientshad GER symptoms requiring acid-suppression medications. Endoscopic evidence of esopha-gitis was present in 21 patients (LA class A=14, B=6, C=1). Multiple variable logistic regressionadjusting for age, gender, BMI, GER diagnosis, and use of acid-suppression medicationsindicated OSA was associated with a 80% increased risk of BE relative to subjects withoutOSA (OR 1.80, 95%CI 1.02-3.10, p=0.04) (table 2). This association was dose-dependentsuggesting an increased risk for BE per 10 unit increase in AHI (OR 1.14, 95% CI 0.99-1.3, p=0.05). Conclusion: Subjects with OSA are at higher risk of BE independent of GERand BMI. This risk is higher with increased OSA severity with a 14% increase in risk of BEfor every 10 unit increase in AHI score.Baseline Characteristics

Multiple variable logistic model for BE Risk Factors

Mo1907

Dietary Intake of Fat, Animal Products and Advanced Glycation End-Productsand the Risk of Barrett's EsophagusLi Jiao, Liang Chen, Jennifer R. Kramer, Massimo Rugge, Paola Parente, GordanaVerstovsek, Abeer Alsarraj, Hashem El-Serag

OBJECTIVES: Diet is a potentially modifiable risk factor for Barrett's esophagus (BE).Advanced glycation end-products (AGEs) are found in high quantity in high-fat foods andmeats cooked at high temperature and have been shown to contribute to chronic inflammationand oxidative stress in humans. We investigated the associations between dietary intake offat, meat and other animal products, and AGEs, and risk of BE. METHODS: This is a case-control study in a single VA Medical Center conducted between 2008 and 2011. Diet inthe past one year was assessed by using a validated self-administered Block food frequencyquestionnaire (FFQ). The daily intake value of N ε-(carboxymethyl)lysine (CML), a majortype of AGEs, was derived from the FFQ using a published dietary AGEs database. Detailedclinical and lifestyle factors were also collected by personal interview. Multivariate logisticregression models were used to estimate the odds ratio (OR) and its 95% confidence interval(CI) for BE. The covariates included age, energy intake, sex, race/ethnicity, smoking status,alcohol consumption, waist to hip ratio (WHR), use of aspirin or proton pump inhibitor,frequency of gastroesophageal reflux (GER) symptoms, and physical activity. Stratified analy-sis was conducted according to WHR and frequency of GER symptoms. RESULTS: A totalof 151 cases with histologically confirmed BE and 777 controls without BE completed theFFQ. Intake of CML-AGE was significantly correlated with intake of saturated fat (r= 0.53)and total meats (r = 0.61). The multivariate OR (95% CI) of BE was 1.86 (1.06-3.24) forsaturated fat intake, 1.57 (0.90 -2.73) for total meat intake, and 1.50 (0.89-2.53) for CML-AGE intake, when the highest tertile was compared with the lowest. When CML-AGE wasadjusted in the models, the association for saturated fat was attenuated to 1.75 (95% CI:0.92-3.32), and that for total meat intake to 1.39 (95% CI: 0.72-2.69). Similarly, theadjustment of saturated fat attenuated the association for CML-AGE to 1.26 (95% CI: 0.69-2.29). The positive associations between CML-AGE and risk of BE was stronger in the studysubjects with a higher WHR (OR = 1.82, 95% CI: 0.94-3.52) or with frequent GER symptoms(. 1 time per month) (OR = 2.69, 95% CI: 1.12-6.42). Dietary intakes of total fat, monounsa-turated fat, polyunsaturated fat, trans fat, cholesterol, omega-3, egg, or dairy products werenot associated with risk of BE. CONCLUSIONS: Higher intakes of saturated fat and potentiallytotal meat and CML-AGE were associated with an increased risk of BE. CML-AGE mayexplain some of the effects of saturated fat and meat intake. The association between CML-AGE and risk of BE seems to be modified by abdominal obesity and GER symptoms.The interrelationship between CML-AGE and saturated fat and their contributions to BEdevelopment warrants further investigation.