This article is more than 5 years old. Information may no longer be current.
Higher mortality risk in Barrett's esophagus primarily due to non-esophageal cancers, CV disease
Patients with Barrett’s esophagus were at a significantly increased risk for overall mortality, with non-esophageal cancers and cardiovascular diseases as the primary causes of death, according to the results of a Danish population-based cohort study.
These findings led investigators to conclude that cardiovascular disease prevention and non-esophageal cancer screening could be more important than esophageal cancer prevention in this patient population.
“We found that overall mortality was 3.2-fold increased in the first year after diagnosis and 1.4-fold increased in the second and subsequent years, compared with an age-, sex- and comorbidity-matched general population cohort,” Rune Erichsen, MD, of the department of clinical epidemiology at Aarhus University Hospital in Denmark, and colleagues wrote. “Cause-specific mortality rates in the Barrett’s esophagus cohort were highest for non-esophageal cancers and for cardiovascular diseases, followed by esophageal cancer.”
Evan S. Dellon
In collaboration with researchers from the University of North Carolina School of Medicine, Chapel Hill — including Evan S. Dellon, MD, MPH, associate professor of medicine and epidemiology at the Center for Esophageal Diseases and Swallowing — Erichsen and colleagues identified 13,435 patients (median age, 61 years; mean follow-up, 4 years) with histologically confirmed Barrett’s esophagus within the Danish Pathology Registry between 1997 and 2011, and compared their risk for mortality and cardiovascular events with 123,526 members of the general population.
They found that the overall mortality rate was 46.7 per 1,000 person-years among Barrett’s patients compared with 27.2 per 1,000 person-years in the general population, corresponding to a 71% relative increase in overall mortality risk among Barrett’s patients (HR = 1.71; 95% CI, 1.64-1.78). The HR was almost 3.2-fold higher in the first year of follow-up and dropped to 1.4-fold higher in the second and subsequent years.
Further, the investigators found that the cause-specific mortality rates among Barrett’s patients were 8.5 per 1,000 person-years for cardiovascular diseases, corresponding to a HR of 1.26 (95% CI, 1.15-1.38); 14.7 per 1,000 person-years for non-esophageal cancers (HR = 1.77; 95% CI, 1.65-1.9), and 5.4 per 1,000 person-years for esophageal cancer (HR = 19.4; 95% CI, 16.1-23.4).
Finally, they found that the rate of cardiovascular diseases was increased among Barrett’s patients. Subarachnoid bleeding incidence was 0.4 per 1,000 person-years in Barrett’s patients vs. 0.2 per 1,000 person-years in the general population (HR = 1.1; 95% CI, 0.87-1.39) and congestive heart failure incidence was 8.1 per 1,000 person-years in Barrett’s patients vs. 5.9 per 1,000 person-years in the general population (HR = 1.33; 95% CI, 1.21-1.46).
The investigators acknowledged that residual confounding from smoking, obesity and alcohol are among the study’s limitations.
“Prophylactic measures against cardiovascular diseases and appropriate screening for non-esophageal cancers potentially could be even more important for improving prognosis in patients with Barrett’s esophagus than preventive measures against esophageal cancer, including surveillance endoscopy,” Erichsen and colleagues concluded. – by Adam Leitenberger
Disclosures: One of the researchers reports he works within a unit supported by the Medical Research Council and the University of Bristol.