Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Dec 1;125(23):4210-4223.
doi: 10.1002/cncr.32444. Epub 2019 Sep 6.

Diabetes in relation to Barrett's esophagus and adenocarcinomas of the esophagus: A pooled study from the International Barrett's and Esophageal Adenocarcinoma Consortium

Jessica L Petrick  1 , Nan Li  2 , Lesley A Anderson  3 , Leslie Bernstein  4 , Douglas A Corley  5 , Hashem B El Serag  6 , Sheetal Hardikar  7   8 , Linda M Liao  1 , Geoffrey Liu  9 , Liam J Murray  3 , Joel H Rubenstein  10   11 , Jennifer L Schneider  5 , Nicholas J Shaheen  12 , Aaron P Thrift  13   14 , Piet A van den Brandt  15 , Thomas L Vaughan  16 , David C Whiteman  17 , Anna H Wu  18 , Wei K Zhao  5 , Marilie D Gammon  19 , Michael B Cook  1
Affiliations

Diabetes in relation to Barrett's esophagus and adenocarcinomas of the esophagus: A pooled study from the International Barrett's and Esophageal Adenocarcinoma Consortium

Jessica L Petrick et al. Cancer. .

Abstract

Background: Diabetes is positively associated with various cancers, but its relationship with tumors of the esophagus/esophagogastric junction remains unclear.

Methods: Data were harmonized across 13 studies in the International Barrett's and Esophageal Adenocarcinoma Consortium, comprising 2309 esophageal adenocarcinoma (EA) cases, 1938 esophagogastric junction adenocarcinoma (EGJA) cases, 1728 Barrett's esophagus (BE) cases, and 16,354 controls. Logistic regression was used to estimate study-specific odds ratios (ORs) and 95% CIs for self-reported diabetes in association with EA, EGJA, and BE. Adjusted ORs were then combined using random-effects meta-analysis.

Results: Diabetes was associated with a 34% increased risk of EA (OR, 1.34; 95% CI, 1.00-1.80; I2 = 48.8% [where 0% indicates no heterogeneity, and larger values indicate increasing heterogeneity between studies]), 27% for EGJA (OR, 1.27; 95% CI, 1.05-1.55; I2 = 0.0%), and 30% for EA/EGJA combined (OR, 1.30; 95% CI, 1.06-1.58; I2 = 34.9%). Regurgitation symptoms modified the diabetes-EA/EGJA association (P for interaction = .04) with a 63% increased risk among participants with regurgitation (OR, 1.63; 95% CI, 1.19-2.22), but not among those without regurgitation (OR, 1.03; 95% CI, 0.74-1.43). No consistent association was found between diabetes and BE.

Conclusions: Diabetes was associated with increased EA and EGJA risk, which was confined to individuals with regurgitation symptoms. Lack of an association between diabetes and BE suggests that diabetes may influence progression of BE to cancer.

Keywords: Barrett esophagus; diabetes; epidemiology; esophageal adenocarcinoma; meta-analysis.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: The authors declare no potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Forrest plot of the relationship between diabetes and (A) esophageal adenocarcinoma, (B) esophagogastric junction adenocarcinoma, and (C) all esophageal and esophagogastric junction adenocarcinomas, by random effects model adjusted for age, sex, smoking (never, ever), and body mass index (continuous).
Figure 1.
Figure 1.
Forrest plot of the relationship between diabetes and (A) esophageal adenocarcinoma, (B) esophagogastric junction adenocarcinoma, and (C) all esophageal and esophagogastric junction adenocarcinomas, by random effects model adjusted for age, sex, smoking (never, ever), and body mass index (continuous).
Figure 1.
Figure 1.
Forrest plot of the relationship between diabetes and (A) esophageal adenocarcinoma, (B) esophagogastric junction adenocarcinoma, and (C) all esophageal and esophagogastric junction adenocarcinomas, by random effects model adjusted for age, sex, smoking (never, ever), and body mass index (continuous).
Figure 2.
Figure 2.
Forrest plot of the relationship between diabetes and Barret155t’s esophagus, versus (A) population controls and (B) GERD/endoscopy controls, by random effects model adjusted for age (continuous), sex, smoking (never, ever), and body mass index (continuous).
Figure 2.
Figure 2.
Forrest plot of the relationship between diabetes and Barret155t’s esophagus, versus (A) population controls and (B) GERD/endoscopy controls, by random effects model adjusted for age (continuous), sex, smoking (never, ever), and body mass index (continuous).
See this image and copyright information in PMC

References

    1. Simard EP, Ward EM, Siegel R, Jemal A. Cancers with increasing incidence trends in the United States: 1999 through 2008. CA Cancer J Clin. 2012;62: 118–128. - PubMed
    1. Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst. 2005;97: 142–146. - PubMed
    1. Islami F, DeSantis CE, Jemal A. Incidence Trends of Esophageal and Gastric Cancer Subtypes by Race, Ethnicity, and Age in the United States, 1997–2014. Clin Gastroenterol Hepatol. 2019;17: 429–439. - PubMed
    1. Devesa SS, Blot WJ, Fraumeni JF, Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer. 1998;83: 2049–2053. - PubMed
    1. Wijnhoven BP, Siersema PD, Hop WC, van Dekken H, Tilanus HW. Adenocarcinomas of the distal oesophagus and gastric cardia are one clinical entity. Rotterdam Oesophageal Tumour Study Group. Br J Surg. 1999;86: 529–535. - PubMed

Publication types

Supplementary concepts