Factors Associated With Progression of Barrett's Esophagus: A Systematic Review and Meta-analysis

Rajesh Krishnamoorthi, Siddharth Singh, Karthik Ragunathan, Kavel Visrodia, Kenneth Ke Ning Wang, David A Katzka, Prasad G Iyer

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background & Aims: Endoscopic surveillance of patients with Barrett's esophagus (BE) is inefficient. Risk stratification of patients might improve the effectiveness of surveillance. We performed a systematic review and meta-analysis to identify factors associated with progression of BE without dysplasia or BE with low-grade dysplasia (LGD) to high-grade dysplasia or esophageal adenocarcinoma. Methods: We performed a systematic search of databases through May 2016 to identify cohort studies of patients with baseline BE without dysplasia or BE with LGD that reported predictors of progression. Pooled estimates (odds ratios) of associations of age, sex, smoking, alcohol use, obesity, baseline LGD, segment length, and medication use with progression were calculated. Results: We identified 20 studies, reporting 1231 events in 74943 patients. The studies associated BE progression with increasing age (12 studies; odds ratio [OR], 1.03; 95% CI, 1.01–1.05), male sex (11 studies; OR, 2.16; 95% CI, 1.84–2.53), ever smoking (current or past, 8 studies; OR, 1.47; 95% CI, 1.09–1.98), and increasing BE segment length (10 studies; OR, 1.25; 95% CI, 1.16–1.36), with a low degree of heterogeneity. LGD was associated with a 4-fold increase in risk of BE progression (11 studies; OR, 4.25; 95% CI, 2.58–7.0). Use of proton pump inhibitors (4 studies; OR, 0.55; 95% CI, 0.32–0.96) or statins (3 studies; OR, 0.48; 95% CI, 0.31–0.73) were associated with lower risk of BE progression. Alcohol use and obesity did not associate with risk of progression. Conclusions: In a systematic review and meta-analysis, we associated older age, male sex, smoking, longer BE segment, and LGD with risk of progression of BE. Individuals with these features should undergo more intensive surveillance or endoscopic therapy. Smoking is a modifiable risk factor for cancer prevention in patients with BE.

Original languageEnglish (US)
JournalClinical Gastroenterology and Hepatology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Barrett Esophagus
Meta-Analysis
Odds Ratio
Smoking
Obesity
Alcohols
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Proton Pump Inhibitors
Adenocarcinoma
Cohort Studies

Keywords

  • Cancer Risk
  • Carcinogenesis
  • EAC
  • Prognostic Factor

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Factors Associated With Progression of Barrett's Esophagus : A Systematic Review and Meta-analysis. / Krishnamoorthi, Rajesh; Singh, Siddharth; Ragunathan, Karthik; Visrodia, Kavel; Wang, Kenneth Ke Ning; Katzka, David A; Iyer, Prasad G.

In: Clinical Gastroenterology and Hepatology, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background & Aims: Endoscopic surveillance of patients with Barrett's esophagus (BE) is inefficient. Risk stratification of patients might improve the effectiveness of surveillance. We performed a systematic review and meta-analysis to identify factors associated with progression of BE without dysplasia or BE with low-grade dysplasia (LGD) to high-grade dysplasia or esophageal adenocarcinoma. Methods: We performed a systematic search of databases through May 2016 to identify cohort studies of patients with baseline BE without dysplasia or BE with LGD that reported predictors of progression. Pooled estimates (odds ratios) of associations of age, sex, smoking, alcohol use, obesity, baseline LGD, segment length, and medication use with progression were calculated. Results: We identified 20 studies, reporting 1231 events in 74943 patients. The studies associated BE progression with increasing age (12 studies; odds ratio [OR], 1.03; 95{\%} CI, 1.01–1.05), male sex (11 studies; OR, 2.16; 95{\%} CI, 1.84–2.53), ever smoking (current or past, 8 studies; OR, 1.47; 95{\%} CI, 1.09–1.98), and increasing BE segment length (10 studies; OR, 1.25; 95{\%} CI, 1.16–1.36), with a low degree of heterogeneity. LGD was associated with a 4-fold increase in risk of BE progression (11 studies; OR, 4.25; 95{\%} CI, 2.58–7.0). Use of proton pump inhibitors (4 studies; OR, 0.55; 95{\%} CI, 0.32–0.96) or statins (3 studies; OR, 0.48; 95{\%} CI, 0.31–0.73) were associated with lower risk of BE progression. Alcohol use and obesity did not associate with risk of progression. Conclusions: In a systematic review and meta-analysis, we associated older age, male sex, smoking, longer BE segment, and LGD with risk of progression of BE. Individuals with these features should undergo more intensive surveillance or endoscopic therapy. Smoking is a modifiable risk factor for cancer prevention in patients with BE.",
keywords = "Cancer Risk, Carcinogenesis, EAC, Prognostic Factor",
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T2 - A Systematic Review and Meta-analysis

AU - Krishnamoorthi, Rajesh

AU - Singh, Siddharth

AU - Ragunathan, Karthik

AU - Visrodia, Kavel

AU - Wang, Kenneth Ke Ning

AU - Katzka, David A

AU - Iyer, Prasad G

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background & Aims: Endoscopic surveillance of patients with Barrett's esophagus (BE) is inefficient. Risk stratification of patients might improve the effectiveness of surveillance. We performed a systematic review and meta-analysis to identify factors associated with progression of BE without dysplasia or BE with low-grade dysplasia (LGD) to high-grade dysplasia or esophageal adenocarcinoma. Methods: We performed a systematic search of databases through May 2016 to identify cohort studies of patients with baseline BE without dysplasia or BE with LGD that reported predictors of progression. Pooled estimates (odds ratios) of associations of age, sex, smoking, alcohol use, obesity, baseline LGD, segment length, and medication use with progression were calculated. Results: We identified 20 studies, reporting 1231 events in 74943 patients. The studies associated BE progression with increasing age (12 studies; odds ratio [OR], 1.03; 95% CI, 1.01–1.05), male sex (11 studies; OR, 2.16; 95% CI, 1.84–2.53), ever smoking (current or past, 8 studies; OR, 1.47; 95% CI, 1.09–1.98), and increasing BE segment length (10 studies; OR, 1.25; 95% CI, 1.16–1.36), with a low degree of heterogeneity. LGD was associated with a 4-fold increase in risk of BE progression (11 studies; OR, 4.25; 95% CI, 2.58–7.0). Use of proton pump inhibitors (4 studies; OR, 0.55; 95% CI, 0.32–0.96) or statins (3 studies; OR, 0.48; 95% CI, 0.31–0.73) were associated with lower risk of BE progression. Alcohol use and obesity did not associate with risk of progression. Conclusions: In a systematic review and meta-analysis, we associated older age, male sex, smoking, longer BE segment, and LGD with risk of progression of BE. Individuals with these features should undergo more intensive surveillance or endoscopic therapy. Smoking is a modifiable risk factor for cancer prevention in patients with BE.

AB - Background & Aims: Endoscopic surveillance of patients with Barrett's esophagus (BE) is inefficient. Risk stratification of patients might improve the effectiveness of surveillance. We performed a systematic review and meta-analysis to identify factors associated with progression of BE without dysplasia or BE with low-grade dysplasia (LGD) to high-grade dysplasia or esophageal adenocarcinoma. Methods: We performed a systematic search of databases through May 2016 to identify cohort studies of patients with baseline BE without dysplasia or BE with LGD that reported predictors of progression. Pooled estimates (odds ratios) of associations of age, sex, smoking, alcohol use, obesity, baseline LGD, segment length, and medication use with progression were calculated. Results: We identified 20 studies, reporting 1231 events in 74943 patients. The studies associated BE progression with increasing age (12 studies; odds ratio [OR], 1.03; 95% CI, 1.01–1.05), male sex (11 studies; OR, 2.16; 95% CI, 1.84–2.53), ever smoking (current or past, 8 studies; OR, 1.47; 95% CI, 1.09–1.98), and increasing BE segment length (10 studies; OR, 1.25; 95% CI, 1.16–1.36), with a low degree of heterogeneity. LGD was associated with a 4-fold increase in risk of BE progression (11 studies; OR, 4.25; 95% CI, 2.58–7.0). Use of proton pump inhibitors (4 studies; OR, 0.55; 95% CI, 0.32–0.96) or statins (3 studies; OR, 0.48; 95% CI, 0.31–0.73) were associated with lower risk of BE progression. Alcohol use and obesity did not associate with risk of progression. Conclusions: In a systematic review and meta-analysis, we associated older age, male sex, smoking, longer BE segment, and LGD with risk of progression of BE. Individuals with these features should undergo more intensive surveillance or endoscopic therapy. Smoking is a modifiable risk factor for cancer prevention in patients with BE.

KW - Cancer Risk

KW - Carcinogenesis

KW - EAC

KW - Prognostic Factor

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