Patients with long-segment Barrett’s esophagus had seven times the risk for progressing to esophageal adenocarcinoma or esophageal high-grade dysplasia than patients with the short-segment condition, according to a recent study.
In a review of hospital records for 3,148 Barrett’s esophagus (BE) patients on Northern Ireland’s BE register,128 patients developed either esophageal high-grade dysplasia (HGD; n=36) or esophageal adenocarcinoma (EAC; n=92). Patients were followed for a mean of 8.9 years.
Long-segment BE (3 cm or longer) patients had an adjusted hazard ratio of 7.1 (95% CI, 1.74–29.04) for progression, with 71 patients advancing to either HGD or EAC. By comparison only two patients with short-segment BE (less than 3 cm) progressed to HGD, but neither advanced to EAC during the study period.
Patients with Barrett’s ulcer also had a statistically significant increased risk for disease progression (aHR=1.72; 95% CI, 1.08–2.76).
Researchers said weight loss served as a potential factor in progression, with patients who lost at least 5 kilograms at an increased risk for cancer even 5 years after BE diagnosis (HR=3.09; 95% CI, 1.27–7.53).
Though reflux symptoms are associated with increased risk for EAC progression, asymptomatic BE patients were at a greater risk (P=.03) for progressing to EAC, although there may be a poor correlation between patient perception of reflux and the actual presence of reflux in the esophagus.
The increased risks merit consideration during BE diagnosis, the researchers concluded.
“BE patients presenting with long-segment Barrett’s or Barrett’s ulceration have an increased risk of progressing to HGD/EAC and should be considered for more intense surveillance,” they said. “The absence of reflux symptoms at diagnosis is not associated with a reduced risk of malignant progression, and may carry an increased risk of progression.”
Disclosure: The researchers report no relevant financial disclosures.