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. 2019 Jun 28;25(24):3069-3078.
doi: 10.3748/wjg.v25.i24.3069.

Clinical characteristics of young patients with early Barrett's neoplasia

Yugo Iwaya  1 , Yuto Shimamura  2 , Kenichi Goda  3 , Enrique Rodríguez de Santiago  4 , John Gerard Coneys  2 , Jeffrey D Mosko  2 , Gabor Kandel  2 , Paul Kortan  2 , Gary May  2 , Norman Marcon  2 , Christopher Teshima  2
Affiliations

Clinical characteristics of young patients with early Barrett's neoplasia

Yugo Iwaya et al. World J Gastroenterol. .

Abstract

Background: Esophageal adenocarcinoma (EAC) and high-grade dysplasia (HGD) may appear in young patients with Barrett's esophagus (BE). However, characteristics of Barrett's-related neoplasia in this younger population remain unknown.

Aim: To identify clinical characteristics that differ between young and old patients with early-stage Barrett's-related neoplasia.

Methods: We conducted a retrospective analysis of a prospectively maintained database comprised of consecutive patients with early-stage EAC (pT1) and HGD at a tertiary-referral center between 2001 and 2017. Baseline characteristics, drug and risk factor exposures, clinicopathological staging of EAC/HGD and treatment outcomes [complete eradication of neoplasia (CE-N), complete eradication of intestinal metaplasia (CE-IM), recurrence of neoplasia and recurrence of intestinal metaplasia] were retrieved. Multivariate analyses were performed to identify factors that differed significantly between older and younger (≤ 50 years) patients.

Results: We identified 450 patients with T1 EAC and HGD (74% and 26%, respectively); 45 (10%) were ≤ 50 years. Compared to the older group, young patients were more likely to present with ongoing gastroesophageal reflux disease (GERD) symptoms (55% vs 38%, P = 0.04) and to be obese (body mass index > 30, 48% vs 32%, P = 0.04). Multivariate logistic regression analysis showed that young patients were significantly more likely to have ongoing GERD symptoms [odds ratio (OR) 2.00, 95% confidence interval (CI) 1.04-3.85, P = 0.04] and to be obese (OR 2.06, 95%CI 1.07-3.98, P = 0.03) whereas the young group was less likely to have a smoking history (OR 0.39, 95%CI 0.20-0.75, P < 0.01) compared to the old group. However, there were no significant differences regarding tumor histology, CE-N, CE-IM, recurrence of neoplasia and recurrence of intestinal metaplasia (mean follow-up, 44.3 mo).

Conclusion: While guidelines recommend BE screening in patients > 50 years of age, younger patients should be considered for screening endoscopy if they suffer from obesity and GERD symptoms.

Keywords: Barrett’s Esophagus; Esophageal adenocarcinoma; Gastroesophageal reflux disease; Guideline; High-grade dysplasia; Obesity; Young patient.

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Conflict of interest statement

Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.

Figures

Figure 1
Figure 1
Flow diagram for the study patients. EAC: Esophageal adenocarcinoma; HGD: High-grade dysplasia; BSC: Best supportive care; EMR: Endoscopic mucosal resection.
See this image and copyright information in PMC

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