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Risk factors for esophageal adenocarcinoma differed based on reflux disease stage
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The risk for esophageal adenocarcinoma was impacted by several factors that varied according to a patient’s stage of reflux disease in a recent study.
In a case-control study, researchers evaluated 188 patients with GERD, 162 with Barrett’s esophagus, 100 with high-grade dysplasia (HGD) or esophageal carcinoma, and 113 patients without GERD. Participants received upper endoscopy and completed questionnaires on their symptoms, diet, prescription medications and social histories.
Factors associated with increased risk for cancer and HGD included elevated BMI, hiatal hernia, tobacco use, male sex, a longer duration of reflux symptoms and a diet low in fruits and vegetables. Hiatal hernia alone was associated with developing GERD (OR=3.62; 95% CI, 2.15-6.09), and risk increased according to hernia size (P<.001 for trend).
Among patients with GERD, associations were observed between Barrett’s esophagus and advanced age (OR=2.96, 1.34-6.51 for patients aged older than 75 years compared to those aged less than 55 years), high BMI (OR=1.99, 0.88-4.50 for obese patients compared with normal weight), heartburn duration (OR=2.41, 1.34-4.31 for those with symptoms for longer than 20 years compared with less than 10 years), hiatal hernia (OR=2.43, 1.50-3.94) and male sex (OR=2.71, 1.70-4.32) (95% CI for all).
Increased risk for cancer and HGD was linked to male sex (OR=2.29, 1.15-4.59), diet (OR=0.60, 0.19-1.91 for those consuming more fruits and vegetables), tobacco use (OR=2.62, 1.38-4.99) and a longer Barrett’s esophagus segment (OR=2.69, 1.48-4.88) among patients with Barrett’s esophagus. Cancer/HGD risk increased by 19% for each 1-cm increase in Barrett length (OR=1.19, 1.09-1.30) (95% CI for all).
“Our study shows that different sets of risk factors are associated with different disease stages in the development to esophageal adenocarcinoma,” the researchers wrote. “Our results suggest that different combinations or varying strengths of individual risk factors may govern the final outcome from the onset. Alternatively, it is also possible that a gradual progression through different stages of disease severity may be mediated by the consecutive and time-dependent action of varying risk factors.”
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