A systematic review and meta-analysis of Barrett's esophagus studies identified several factors that may predict the risk of progression to high-grade dysplasia or esophageal adenocarcinoma.
Researchers conducted a systematic search of databases through May 2016 and identified 20 studies that included patients with baseline Barrett's esophagus and no or low-grade dysplasia and reported predictors of progression. In total, 1,231 progression events occurred among 74,943 patients. The systematic review and meta-analysis looked for associations between events and age, sex, smoking, alcohol use, obesity, baseline low-grade dysplasia, segment length, and medication use. Results were published by Clinical Gastroenterology and Hepatology on Nov. 30.
Progression was found to be significantly associated with increasing age (12 studies; odds ratio [OR], 1.03; 95% CI, 1.01 to 1.05), male sex (11 studies; OR, 2.16; 95% CI, 1.84 to 2.53), smoking (current or past, eight studies; OR, 1.47; 95% CI, 1.09 to 1.98), and increasing segment length (10 studies; OR, 1.25; 95% CI, 1.16 to 1.36), with a low degree of heterogeneity. Having low-grade dysplasia at baseline was associated with a fourfold increase in risk of progression (11 studies; OR, 4.25; 95% CI, 2.58 to 7.0). Use of proton-pump inhibitors (four studies; OR, 0.55; 95% CI, 0.32 to 0.96) or statins (three studies; OR, 0.48; 95% CI, 0.31 to 0.73) was associated with lower risk of progression. There was no association between alcohol use or obesity and progression, and NSAIDs showed a protective effect that did not reach statistical significance.
The results of the review could be used to develop a risk score to identify patients with Barrett's esophagus at higher risk of progression, according to the study authors. “Currently, GI societies' guidelines on [Barrett's esophagus] surveillance are solely based on dysplasia grade and do not take into account any of the other risk factors,” they wrote. Guidelines do currently recommend considering endoscopic ablation in patients with low-grade dysplasia, which the review's findings would support, the authors noted. It's also important to note that smoking was the only reversible risk factor identified.
Limitations of the study included failure of some of the included studies to adjust for known confounders and insufficient data to assess dose- and duration-response relationships for factors such as smoking, alcohol, and medication use, the authors said.