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Diabetes linked to increased risk for Barrett’s esophagus
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Patients with diabetes are more likely to develop Barrett’s esophagus, regardless of the presence or absence of other risk factors including tobacco use, GERD and obesity, according to a recent study.
In a population-based case-control study, researchers evaluated data on 14,245 patients with Barrett’s esophagus (BE) and 70,361 matched controls, collected from the General Practice Research Database. Incidence of diabetes (DM2) diagnosis prior to BE, defined as a baseline diagnosis along with a medication code indicating an insulin or oral hypoglycemic prescription filled prior to initial BE diagnosis, was recorded and compared between the groups.
A prior DM2 diagnosis occurred more frequently among those with BE (5.8% vs. 5.3% of controls; OR=1.1, 95% CI, 1.02-1.19). Analysis using only a DM2 diagnosis to define DM2 yielded a numerically but nonsignificantly higher rate of 7.48% in the BE group, compared with 7.07% among controls.
After adjustment for confounders including smoking, obesity and a GERD diagnosis at baseline, multivariate analysis indicated an independent association between BE and prior DM2 diagnosis (OR=1.49, 1.16-1.91). DM2 defined solely as a DM2 diagnosis (n=12,511 cases and 52,140 controls) reduced but did not eliminate the significance of this association (OR=1.27, 1.04-1.55). Investigators noted that the association was more pronounced among females (OR=1.41, 0.982-2.017 compared with OR=-1.13, 0.865-1.477) (95% CI for all).
Analysis in which BE was defined as the presence of two or more BE diagnostic codes, along with an endoscopy code following initial diagnosis (n=1,170 cases and 4,834 controls), yielded a stronger association between DM2 and BE risk (OR=4.24, 1.39-12.91). Defining BE only as two or more diagnostic codes following initial diagnosis (n=5,664 cases and 23,109 controls) rendered the association nonsignificant (OR=1.35, 0.87-2.09) (95% CI for both).
“DM2 was found to be a risk factor for BE, independent of smoking, obesity … and a diagnosis of gastroesophageal reflux,” the researchers wrote. “… Patients with DM2 may be at a higher risk of developing BE and, potentially, esophageal adenocarcinoma. Prospective studies are needed to confirm this association.”
Disclosure: Researchers Prasag G. Iyer, MD and Amitabh Chak, MD reported receiving research funding from Takeda Pharmaceuticals.
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