Reflux control is important in the management of Barrett's Esophagus: results from a retrospective 1,830 patient cohort

Surg Endosc. 2015 Dec;29(12):3528-34. doi: 10.1007/s00464-015-4103-3. Epub 2015 Feb 13.

Abstract

Background: It is unknown whether acid/reflux control prevents progression in Barrett's esophagus. In this study, we investigate whether medical or surgical control of reflux is associated with a decreased risk of progression to dysplasia/esophageal adenocarcinoma.

Methods: We retrospectively collected and analyzed data from a cohort of Barrett's esophagus patients participating in this single-center study comprised of all patients diagnosed with Barrett's esophagus at NorthShore University Health System hospitals and clinics over a 10-year period. Patients were followed in order to identify those progressing from Barrett's esophagus to low-grade dysplasia, high-grade dysplasia, and esophageal adenocarcinoma. We collected information from the patient's electronic medical records regarding demographic, endoscopic findings, histological findings, smoking/alcohol history, medication use including proton-pump inhibitors, and history of bariatric and antireflux surgery. Risk-adjusted modeling was performed using multivariable logistic regression.

Results: This study included 1,830 total Barrett's esophagus patients, 102 of which had their Barrett's esophagus progress to low-grade dysplasia, high-grade dysplasia, or esophageal adenocarcinoma (confirmed by biopsy) with an annual incidence rate of 1.1%. Mean follow-up period was 5.51 years (10,083 patient-years). Compared to the group that did not progress, the group that progressed was older (69.3 ± 13.7 vs. 63.9 ± 13.4 years. p < 0.001) and likely to be male (75 vs. 61%, p < 0.01). In the multivariable analysis, patients who had a history of antireflux surgery (n = 44) or proton-pump inhibitor use without surgery (n = 1,641) were found to progress at significantly lower rates than patients who did not have antireflux surgery or were not taking PPI's (OR 0.18, 95% CI 0.09-0.36).

Conclusions: Reflux control was associated with decreased risk of progression to low-grade dysplasia, high-grade dysplasia, or esophageal adenocarcinoma. These results support the use of reflux control strategies such as proton-pump inhibitor therapy or surgery in patients with non-dysplastic Barrett's esophagus for the prevention of progression to dysplasia/adenocarcinoma.

Keywords: Barrett’s esophagus; Esophageal adenocarcinoma; Gastroesophageal reflux disease; Proton-pump inhibitor.

MeSH terms

  • Adenocarcinoma / etiology
  • Aged
  • Angiotensin-Converting Enzyme Inhibitors / adverse effects
  • Barrett Esophagus / complications
  • Barrett Esophagus / therapy*
  • Cell Transformation, Neoplastic
  • Disease Progression
  • Esophageal Neoplasms / etiology
  • Female
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / prevention & control*
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Proton Pump Inhibitors / therapeutic use
  • Retrospective Studies
  • Risk Factors
  • Vitamin D / administration & dosage

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Proton Pump Inhibitors
  • Vitamin D

Supplementary concepts

  • Adenocarcinoma Of Esophagus