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Patients with GERD may experience higher risk for Barrett’s esophagus from oral bisphosphonate
Use of oral bisphosphonates to treat or prevent osteoporosis may lead to a higher risk for Barrett’s esophagus, particularly for patients with GERD, according to study data.
“Use … was associated with a greater than twofold increase in risk of BE [Barrett’s esophagus] than in control patients after adjustment for sex, age, race, PPI [proton pump inhibitor] use, hiatal hernia, waist–hip ratio, Helicobacter pylori infection and GERD symptoms,” the researchers wrote. “The association between oral bisphosphonates and BE was seen only among patients with frequent GERD symptoms, PPI use or both.”
The case-control study analyzed 285 BE patients and control groups composed of 1,122 endoscopy patients and 496 primary care patients at a single Veterans Affairs medical center. All patients (mean age, 60.5 years; 92.3% men) were scheduled for elective esophagogastroduodenoscopy (EGD) and underwent a study EGD. Oral bisphosphonate use was confirmed via electronic pharmacy records.
Researchers found the proportion of BE cases with filled prescriptions for oral bisphosphonates was 4.6%, which exceeded those among primary care (2.9%) or endoscopy controls (1.6%).
A multiple regression analysis determined oral bisphosphonate usage was significantly associated with BE risk (OR=2.33; 95% CI, 1.11-4.88) compared with control groups and with each group individually (OR=2.74; 95% CI, 1.28–5.87 vs. endoscopy controls; OR=2.6; 95% CI, 0.99–6.84 vs. primary care controls). Researchers said the primary care comparison was limited because only eight patients used bisphosphonates.
The association between bisphosphonate use and BE grew stronger when only GERD patients were analyzed (OR=3.29; 95% CI, 1.36–7.97), when only patients using PPIs were analyzed (OR=2.71; 95% CI, 1.15–6.41) and when patients not using nonsteroidal anti-inflammatory drugs were analyzed (OR=4.51; 95% CI, 1.49–13.65).
The study was limited by its single-center nature and patients’ advanced age, as well as some uncertainty about the use of bisphosphonates, the investigators wrote.
“Additional studies are needed to further examine this association, as it could suggest an increased risk of esophageal cancer in oral bisphosphonate users,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.