Reflux control associated with decreased progression in patients with Barrett's esophagus

CHICAGO — Reflux control, either by anti-reflux surgery or through medical use of proton pump inhibitors, was associated with a decreased risk of progression to low-grade dysplasia, high-grade dysplasia or esophageal adenocarcinoma in Barrett’s esophagus patients without dysplasia, according to data presented at a Presidential Plenary session at Digestive Disease Week 2014.

Researchers conducted a single-center study of a retrospective cohort of 1,830 patients diagnosed with Barrett’s esophagus between January 2000 and November 2010. Primary outcome was progression to low- or high-grade dysplasia, adenocarcinoma or a combination of the three. Of all patients, 102 progressed to low-grade dysplasia, high-grade dysplasia or esophageal adenocarcinoma; average follow-up was 5.51 years. The annual incidence rate of high-grade dysplasia or adenocarcinoma was 0.5%.

According to the results presented by Craig S. Brown, MD, of the Biological Sciences Division, University of Chicago Pritzker School of Medicine, more than 92% of patients experienced reflux control and 72% had a lack of regression. Univariate analysis revealed older males were more likely to progress (69.3 years compared with 63.9 years in the group that didn’t progress, P<.001). Longer segment length was also associated with an increased risk for progression (6.13 cm among those who progressed vs. 2.68 cm among those who did not); 20.3% of patients who did not progress had long segment disease vs. 58.5% of those who did progress.

In multivariate analysis, patients who had antireflux surgery (n=44) or used PPIs without surgery (n=1,708) seemed to progress at lower rates than patients who did not have medical or surgical interventions (OR=0.23; 95% CI, 0.12-0.42). Limitations of the study included patient compliance with the use of PPIs, accuracy of medical records and a biased cohort of patients which could not currently be generalized to the overall population.

Brown said the researchers had identified five independent risk factors for progression from Barrett’s esophagus to dysplasia or esophageal adenocarcinoma. These included patient age of greater than 75 years, segment length, lack of regression, presence of candidiasis and lack of reflux control. According to Brown, the odds for progression to dysplastic disease or adenocarcinoma were fivefold higher among patients without reflux control during follow-up compared with those whose reflux was controlled.

“Reflux control is the only modifiable risk factor that we found to be associated with a risk of progression and we think this result underscores the importance of tight reflux control in managing patients,” he said. - by Melinda Stevens

For more information:

Brown C. #231. Presented at Digestive Disease Week 2014; May 3-6; Chicago.

Disclosure: Goldstein reports a consulting relationship with Pozen. Linn reports financial relationships with Covidien and WL Gore. Ujiki reports financial relationships with Gore and Olympus. All other researchers report no relevant financial disclosures.