Colorectal neoplasia in veterans is associated with Barrett's esophagus but not with proton-pump inhibitor or aspirin/NSAID use

Gastrointest Endosc. 2006 Apr;63(4):581-6. doi: 10.1016/j.gie.2005.08.043.


Background: It has been suggested that Barrett's esophagus (BE) is associated with an increased risk of developing colorectal neoplasia, but this has not been reported consistently.

Aim: To study whether BE is associated with an increased risk of colorectal neoplasia, and if it is, whether it is dependent on use of proton-pump inhibitors (PPIs) or aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).

Design: Case-control study.

Setting: Endoscopic database of the Palo Alto Veterans Affairs Health Care System.

Population: 268 veterans with BE were matched with 268 controls without BE.

Intervention: Controls had undergone upper GI endoscopy within 14 days of the corresponding case. Colonoscopy was performed within 6 months in cases and controls.

Main outcome measure: Development of colorectal neoplasia.

Results: Colorectal neoplasia was present in 162 of 268 (60%) BE patients and in 105 of 268 (40%) controls (p < 0.001). The presence of BE (odds ratio [OR] 2.02: 95% CI [1.35, 3.04]), but also increasing age (OR 1.24 per decade: 95% CI [1.04, 1.48]) and alcohol use (OR 1.70: 95% CI [1.16, 2.50]) were associated with an increased risk of colorectal neoplasia in multivariable logistic regression analysis, whereas PPIs (OR 0.99: 95% CI [0.66, 1.48]) and aspirin/NSAIDs (OR 0.90: 95% CI [0.61, 1.33]) had no meaningful effect.

Limitations: This was a retrospective study in mostly male veterans.

Conclusions: Veterans with BE are at an increased risk of developing colorectal neoplasia. This association is independent from the use of PPIs or aspirin/NSAIDs.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Aspirin / therapeutic use*
  • Barrett Esophagus / complications*
  • Barrett Esophagus / drug therapy
  • Barrett Esophagus / pathology
  • Biopsy
  • California / epidemiology
  • Colorectal Neoplasms / epidemiology
  • Colorectal Neoplasms / etiology*
  • Colorectal Neoplasms / pathology
  • Enzyme Inhibitors / therapeutic use*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Prevalence
  • Proton Pump Inhibitors*
  • Retrospective Studies
  • Risk Factors
  • Sigmoidoscopy
  • Veterans*


  • Anti-Inflammatory Agents, Non-Steroidal
  • Enzyme Inhibitors
  • Proton Pump Inhibitors
  • Aspirin