Women with systemic sclerosis or scleroderma (SSc) should be included in screening recommendations for Barrett’s esophagus and treated accordingly if dysplasia is found, according to the results of a study published in The American Journal of Gastroenterology.
Although there is an association between SSc and Barrett esophagus, the reported rate of progression of Barrett esophagus into high-grade dysplasia and esophageal adenocarcinoma in patients, particularly women, with SSc is low and is based on older studies with small sample sizes. Therefore, researchers assessed the prevalence of Barrett esophagus in a large cohort of 235 women with SSc who underwent esophagogastroduodenoscopy between 2002 and 2020 at the Mayo Clinic Arizona Rheumatology Clinic. Among these women, high-resolution manometry was completed in 172 patients.
The researchers found that women with SSc with Barrett esophagus were significantly more likely to have scleroderma esophagus (absent contractility with hypotensive lower esophageal sphincter) on high-resolution manometry than women with SSc without Barrett esophagus (P=.018). The investigators identified 30 patients with SSc (12.8%) with histologically proven Barrett esophagus. In addition, the proportion of patients with classic symptoms of gastroesophageal reflux disease (heartburn and/or regurgitation) was significantly higher in women with Barrett esophagus than in those without the condition. Dysplasia was found in 13 (43.3%) women: 4 with indefinite, 7 with low grade, and 2 with adenocarcinoma. The prevalence of any dysplasia including adenocarcinoma was high with a calculated incidence of 5.3% per year (0.9% per year for adenocarcinoma).
The authors concluded, “This the largest study on prevalence of [Barrett esophagus] in women with SSc, yielding a prevalence of 12.8%.” They added, “The high prevalence and incidence of dysplasia found suggest that women with SSc should be included in the screening recommendations for [Barrett esophagus].”
Snyder DL, Crowell MD, Kahn A, Griffing WL, Umar S, Ramirez FC. Prevalence of Barrett’s esophagus in female patients with scleroderma. Am J Gastroenterol. Published online January 7, 2021. doi:https://doi.org/10.14309/ajg.0000000000001109