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Diabetes linked to progression of Barrett’s esophagus to high-grade dysplasia, cancer
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SAN DIEGO — Patients with diabetes and Barrett’s esophagus were at greater risk than nondiabetic patients to experience progression to dysplasia and esophageal cancer in a study presented at the American College of Gastroenterology Annual Scientific Meeting.
Researchers evaluated 1,623 patients with Barrett’s esophagus (BE) treated at Cleveland Clinic between Dec. 1, 2000 and March 31, 2013. The cohort included 274 patients with diabetes mellitus (DM) diagnosed before BE diagnosis or during follow-up.
“Recent case-control studies showed metabolic syndrome as a risk factor for BE and esophageal adenocarcinoma,” researcher Prashanthi N. Thota, MD, Cleveland Clinic, told Healio.com. “DM by itself is associated with increased risk of BE and esophageal adenocarcinoma. This appears to be independent of obesity or GERD symptoms. Whether diabetes is a risk factor for progression to dysplasia or cancer in BE is not known. Our aims are to determine the prevalence of dysplasia in our BE population with diabetes and if they were at higher risk of progression to high-grade dysplasia (HGD) or cancer during the follow-up.”
Prashanthi N. Thota
Patients with DM were significantly older at BE diagnosis (P<.001) and had hypertension more frequently than controls without DM (81.4% of patients vs. 33.8%; P<.001). Those with DM also were more likely to have dysplasia or cancer, both on initial endoscopy (P=.004) and during follow-up (P<.001). The groups did not differ significantly according to age, sex, length of BE, size of hiatal hernia, amount of endoscopies performed or duration of follow-up. Multivariate analysis indicated that patients with diabetes had significantly increased risk for progression to either HGD or cancer than nondiabetic patients (HR=2.3; 95% CI, 1.2-4.5).
“Patients with DM have higher prevalence of Barrett’s dysplasia/cancer,” the researchers concluded. “They also had more than two-fold higher risk of progression of dysplasia in BE.” Thota said the observed increase in esophageal cancer may be attributable to an increased prevalence of metabolic syndrome among diabetic patients.
Disclosure: The researchers report no relevant financial disclosures.
For more information:
Thota PN. P1: Is Diabetes Associated with Progression to Dysplasia or Cancer in Barrett's Esophagus? Presented at: the 2013 American College of Gastroenterology Annual Scientific Meeting; Oct. 11-16, San Diego.