The prevalence of Barrett esophagus has noticeably declined in patients with gastroesophageal reflux disease (GERD) over the last 2 decades. Concurrent with this finding has been an increased trend in the use of proton pump inhibitors (PPIs) and aspirin therapy, as well as a decrease in cigarette smoking. It is therefore possible that these modifiable risk factors are contributing to the decreased frequency of Barrett esophagus in patients with GERD, according to the results of a study published in Diseases of the Esophagus.
A team of investigators from the Department of Veterans Affairs Medical Center in Kansas City, Missouri, conducted a study involving patients with GERD symptoms to assess the frequency of newly diagnosed Barrett esophagus over time. They collected information for the study between 1998 and 2015 from patients being evaluated for GERD symptoms at a single tertiary referral center.
The investigators used a validated GERD questionnaire that noted the start of GERD symptoms (heartburn and acid regurgitation) and evaluated the frequency and severity of symptoms. The researchers also collected patient demographic information and body mass index (BMI), as well as the use of aspirin, nonsteroidal anti-inflammatory drugs, and acid suppression therapy, if applicable. They documented smoking status; family history of Barrett esophagus; and presence of erosive esophagitis, Barrett esophagus, and/or hiatal hernia.
The investigators compared patients assessed during the period of 1998 to 2003 (control) and those who presented in later years (3-year cohorts) using the χ2 test, as well as a multivariable logistic regression model to assess independent predictors. They included a total of 1109 patients in the study. The mean age was 56.9±12.8 years; 93% were men; 83% were White; and mean BMI was 29.7±5.6.
The investigators discovered that 226 (20.4%) patients were diagnosed with Barrett esophagus, with a mean length of 2±2.6 cm. The researchers noted a significant decrease in frequency of Barrett esophagus over time from 24.3% in 1998-2003 to 13.6% in 2013-2015 (P =.002). During the same time period, there was noted to be a significant increase in use of PPIs (41.7% in 1998-2003 vs 80.2% in 2013-2015; P <.001) and aspirin (23.7% in 1998-2003 vs 25.9% in 2013-2015; P =.034). There was also noted to be a significant decrease in cigarette smoking.
This study was limited by the use of patient surveys, which could result in recall bias; the unequal number of patients during different time periods; and the inclusion of patients from a single tertiary medical center that likely had high rates of GERD and Barrett esophagus.
In conclusion, it remains uncertain whether the decreased prevalence of Barrett esophagus as identified by this research will contribute to a reduction in the incidence of esophageal adenocarcinoma.
Hamade N, Weng G, Desai M, et al. Significant decline in the prevalence of Barrett’s esophagus among patients with gastroesophageal reflux disease. Dis Esophagus. Published online January 16, 2021. doi:10.1093/dote/doaa131