Prasad G. Iyer
Older age, male sex, smoking, longer Barrett’s esophagus segment and low-grade dysplasia all predicted progression of Barrett’s esophagus, according to the results of a recent systematic review and meta-analysis.
Investigators noted that patients with these features may benefit from more intensive surveillance or endoscopic therapy.
“Predictors of progression to [high grade dysplasia/esophageal adenocarcinoma] in BE are not well defined,” Prasad G. Iyer, MD, of the division of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minn., told Healio Gastroenterology and Liver Disease. “In a systematic review and meta-analysis of 20 studies (including 74,943 BE patients of whom 1231 progressed to HGD or EAC), we found that increasing age, male sex, history of or current smoking, increasing BE segment length and a confirmed diagnosis of LGD was associated with a higher risk of progression. Conversely, use of PPIs or statins was associated with a lower risk of progression in BE subjects. Alcohol use or obesity as measured by BMI did not predict progression. These factors could be used to develop a progression risk score which can be utilized in guiding the management of these patients.”
Aiming to better establish these factors, Iyer and colleagues reviewed medical literature published through May 2016 and analyzed 20 cohort studies reporting data on 1,231 events in 74,943 patients with baseline Barrett’s esophagus without dysplasia or Barrett’s esophagus with low grade dysplasia.
They associated the following factors with Barrett’s esophagus progression:
- increasing age (OR = 1.03; 95% CI, 1.01–1.05);
- male sex (OR = 2.16; 95% CI, 1.84–2.53);
- current or past smoking (OR = 1.47; 95% CI, 1.09–1.98); and
- increasing Barrett’s esophagus segment length (OR = 1.25; 95% CI, 1.16–1.36).
The researchers noted there was a low degree of heterogeneity between studies.
Additionally, they found patients with low grade dysplasia showed a fourfold higher risk for Barrett’s esophagus progression (OR = 4.25; 95% CI, 2.58–7), but noted there was significant heterogeneity across these studies.
“These estimates support the current GI societies’ guidelines to consider endoscopic ablation in BE subjects with LGD in addition to conventional recommendation of surveillance endoscopies every 6-12 months,” Iyer and colleagues wrote.
In contrast, investigators found that patients who used PPIs (OR = 0.55; 95% CI, 0.32–0.96) or statins (OR = 0.48; 95% CI, 0.31–0.73) showed a lower risk for Barrett’s esophagus progression. NSAID use showed a protective effect that did not reach statistical significance when all the studies were pooled, but the association did reach statistical significance when restricting the analysis to studies that reported multivariate analysis adjusted for age and sex (OR = 0.68, 95% CI; 0.48-0.97) and for age, sex and BE characteristics (OR = 0.49; 95% CI, 0.3-0.8).
Finally, they found no link between progression and alcohol use or obesity.
“Among the factors that were identified to have predictive role, smoking is a modifiable risk factor for cancer prevention in BE subjects,” Iyer and colleagues noted. – by Adam Leitenberger
Disclosures: The authors report no relevant financial disclosures.