Barrett Esophagus Progression Most Common Among Older Men, Smokers
Among individuals with Barrett esophagus (BE), the risk of progression is highest among older men, smokers, and individuals with a longer Barrett esophagus (BE) segment and/or low-grade dysplasia (LGD), according to a recent review.
Endoscopic surveillance of patients with BE has been insufficient. However, identifying patients with a higher risk of BE progression could potentially improve the effectiveness of surveillance.
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For their review, the researchers identified and evaluated 20 studies through May 2016, which included 74,943 patients and 1231 reported events. Study data were obtained through a systematic database search. Studies that met inclusion criteria had assessed patients with BE without dysplasia or BE with LGD and had reported predictors of BE progression.
Odds ratios (ORs) were calculated to determine whether factors such as age, sex, smoking, baseline LGD, and segment length affected BE progression.
Results of the review showed that BE progression was associated with increasing age (OR 1.03), male sex (OR 2.16), ever smoking (OR 1.47), and increasing BE segment length (OR 1.25). Additionally, LGD increased the risk of BE progression 4-fold.
The researchers noted that proton pump inhibitor use (OR 0.55) or statin use (0.48) were associated with a lower risk of BE progression, while alcohol use and obesity were not at all associated with the risk of BE progression.
“In a systematic review and meta-analysis, we associated older age, male sex, smoking, longer BE segment, and LGD with risk of progression of BE,” the researchers concluded. “Individuals with these features should undergo more intensive surveillance or endoscopic therapy. Smoking is a modifiable risk factor for cancer prevention in patients with BE.”
—Christina Vogt
Reference:
Krishnamoorthi R, Singh S, Ragunathan K, et al. Factors associated with progression of Barrett’s esophagus: a systematic review and meta-analysis [Published online November 30, 2017]. Clin Gastroenterol Hepatol. http://www.cghjournal.org/article/S1542-3565(17)31417-9/fulltext?rss=yes.