Purpose of review: To summarize the emerging data on the risk factors for Barrett's esophagus and risk stratification tools.
Recent findings: Obesity, particularly abdominal obesity, is associated with Barrett's esophagus, likely because of both mechanical effects promoting gastroesophageal reflux and nonmechanical effects. Circulating peptides related to obesity alter the risk of Barrett's esophagus and may work synergistically with gastroesophageal reflux. Tobacco use is an underappreciated risk for Barrett's esophagus. A number of genetic variants have been associated with Barrett's esophagus, involving pathways in esophageal development. Risk stratification tools are becoming available that have modest discriminatory capability and good calibration.
Summary: The developing understanding of risk factors for Barrett's esophagus is shifting the clinical guidelines to a nuanced approach incorporating multiple risk factors to select patients for screening for Barrett's esophagus.