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. 2020 Mar 17;10(1):4899.
doi: 10.1038/s41598-020-61874-7.

Risk Factors for Progression of Barrett's Esophagus to High Grade Dysplasia and Esophageal Adenocarcinoma

Swetha Kambhampati Thiruvengadam  1 , Alan H Tieu  2   3 , Brandon Luber  4 , Hao Wang  4 , Stephen J Meltzer  5   6
Affiliations

Risk Factors for Progression of Barrett's Esophagus to High Grade Dysplasia and Esophageal Adenocarcinoma

Swetha Kambhampati Thiruvengadam et al. Sci Rep. .

Abstract

Barrett's esophagus (BE) is the only known precursor to esophageal adenocarcinoma (EAC). Methods of identifying BE patients at high risk for progression to high-grade dysplasia (HGD) or EAC are needed to improve outcomes and identify who will benefit most from intensive surveillance or ablative therapy. Clinical predictors of BE progression to HGD or EAC are poorly understood, with multiple contradictory studies. We performed a retrospective study which included 460 patients at Johns Hopkins Hospital who underwent at least 2 upper endoscopies 6 months apart showing biopsy-documented BE between 1992 and 2013. Patients with EAC or HGD at the initial endoscopy were excluded. Demographic, clinicopathological, and endoscopic data were collected. Univariate and multivariate Cox proportional hazards analyses with time to progression to HGD and EAC were performed. Among 460 patients included in the study, 132 BE patients developed HGD and 62 developed EAC. Significant EAC risk factors included age, abdominal obesity, caffeine intake, and the presence of HGD. Risk factors for HGD or EAC included age, caffeine intake, and low-grade dysplasia while colonic adenomas trended towards significance. Notably, a history of statin or SSRI usage reduced the risk of EAC or HGD by 49% or 61%, respectively. Our study validated several known and identified several novel risk factors, including a history of colonic adenomas or caffeine usage. Low-grade dysplasia was a risk factor for progression but various endoscopic characteristics were not, suggesting that screening strategies should focus on histology instead. We identified SSRIs as a new potentially chemoprotective medication.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flow-chart of patients enrolled in the study and their outcomes in regard to progression.
Figure 2
Figure 2
Cumulative Incidence Curves for progression to HGD and EAC for BE patients.
Figure 3
Figure 3
Univariate (A) and Multivariate (B) Cox Proportional Hazards Ratios for EAC.
Figure 4
Figure 4
Kaplan–Meier Survival Curves for progression to HGD (A), EAC (B), and HGD/EAC (C) comparing SSRI users and non-SSRI users.
Figure 5
Figure 5
Multivariate Cox Proportional Hazards Ratio for EAC/HGD.
See this image and copyright information in PMC

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