Patients with Barrett’s esophagus who also have diabetes are at increased risk for the esophageal disease to progress to dysplasia or cancer, although the opposite was the case for hypertension, a researcher reported here.

Among patients with Barrett’s esophagus, the risk of progression for those with diabetes was more than doubled (HR 2.3, 95% CI 1.2-4.5, P=0.01), according to Prashanthi N. Thota, MD, and colleagues from the Cleveland Clinic.

However, among the same cohort, patients without high blood pressure had twice the risk of progression (HR 2.2, 95% CI 1.2-3.9, P=0.009), the researchers reported in a poster session at the annual meeting of the American College of Gastroenterology here.

“There has been a rising incidence of metabolic syndrome over the past few decades, which seems to correlate with an increase in esophageal cancer,” Thota told MedPage Today.

Diabetes is a component of the metabolic syndrome and has been linked with Barrett’s esophagus, but its precise prevalence in Barrett’s patients and the associated adenocarcinoma risk have not previously been quantified. To examine this, Thota and colleagues analyzed data from a cohort of 1,623 patients with Barrett’s esophagus seen between December 2000 and March 2013. A total of 274 patients either had, or were diagnosed with diabetes during the study period. Patients with diabetes were older(64 versus 59.6 years, P<0.001) and were more likely to be hypertensive (81.4% versus 33.8%, P<0.001).

No significant differences were seen for sex (P=0.13), race (P=0.099), length of the Barrett’s esophagus segment (P=0.53), or size of hiatal hernia (P=0.17). However, higher rates of those without diabetes showed no evidence of dysplasia on initial endoscopy (62.3% versus 55.5%, P=0.004). On the biopsy with the most severe findings during approximately 16 months of follow-up, no dysplasia was found in 56.9% of those without diabetes and in 51.5% of those with diabetes, while adenocarcinoma was found in 15.8% of those without diabetes and in 25.9% of those with diabetes (P<0.001). Progression to high-grade dysplasia or cancer was seen in almost twice as many patients with diabetes (17.9% versus 9.7%, P=0.018). Thota and colleagues also examined the potential contribution of hypertension to risk for progression in their Barrett's cohort, noting that high blood pressure is more common in patients with Barrett's esophagus than in the general population. A total of 41.8% of patients had hypertension, and of those who were hypertensive, 32.8% had diabetes, while among those who were normotensive, 5.4% had diabetes. Those who had hypertension were older, averaging 63.9 at the time of Barrett’s diagnosis compared with 57.9 among those without elevated blood pressure. Length of the Barrett’s segments was longer in those without hypertension (3.3 cm versus 2.7 cm, P=0.003), but no differences were seen in sex (P=0.55), race (P=0.067) or hernia size (P=0.78). During 17.6 months of follow-up, 61.9% of patients with hypertension had no dysplasia, compared with 56% of patients without hypertension throughout 14.6 months of follow-up (P=0.02). A total of 10.9% and 10% of those with hypertension developed low- and high-grade dysplasia, respectively, as did 15% and 12.6% of those who were normotensive, while 16.3% of patients with hypertension developed adenocarcinoma as did 17.2% of those without hypertension. The finding that hypertensive patients had a twofold lower risk for progression was “unexpected,” and needs further study. “I suspect that this relates to the use of antihypertensive drugs rather than the condition per se,” Thota explained. ### Primary source: American College of Gastroenterology Source reference: Thota P, et al “Is diabetes associated with progression to dysplasia or cancer in Barrett’s esophagus?” ACG 2013; Poster P1. Additional source: American College of Gastroenterology Source reference:Thota P, et al “Hypertension is associated with reduced risk of progression to dysplasia/cancer in Barrett’s esophagus” ACG 2013; Poster P2.