Diabetes Ups Esophageal Ca Risk

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).

Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

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.