Christopher A. Toivonen, BA, Yazan Addasi, MD, Sirish Rao, MD, Ryan Walters, PhD, Kalyana Nandipati, MD, Subhash Chandra, MBBS; Creighton University School of Medicine, Omaha, NE
Introduction: Mucosal damage from gastroesophageal reflux (GER) is a known risk factor for Barrett’s esophagus (BE). Additional risk factors include advanced age, male sex, smoking, obesity, and Caucasian race. Distal mean nocturnal basal impedance (dMNBI) reflects increased mucosal permeability from GER related damage. It has been validated and proposed as a novel metric to assess GER in clinical guidelines. We studied impact of individual BE risk factors on degree of GER and mucosal damage from GER. Methods: Consecutive patients were included who underwent pH-impedance monitoring off of proton pump inhibitor (PPI) therapy for refractory gastroesophageal reflux disorder (GERD) at our center from Oct 2013 through March 2020. Patients with achalasia, esophagogastric junction outflow obstruction and scleroderma were excluded. Acid exposure time (AET) used to determine degree of GER. Mucosal damage was assessed using dMNBI which was calculated as the average impedance of three uninterrupted 10-minute intervals collected at night from a sensor located 3 cm proximal to the gastroesophageal junction. The associations between AET and Barrett’s esophagus risk factors were assessed on univariable and multivariable linear regression models. Results: A total of 267 patients underwent pH-impedance monitoring off of PPI therapy. Of these, 5 completed less than 12 hours of study, 33 met exclusion criteria and 219 patients were included in the analysis. Table 1 summarizes univariate analysis to demonstrate the association between the BE risk factors, AET, and dMNBI. All BE risk factors had inverse relationships with dMNBI but AET only increased with age and BMI. On multivariate analysis, as shown in table 2, AET and Caucasian race had a significant inverse correlation. Male gender had a borderline trend, while age, BMI, and smoking had no association with dMNBI. Discussion: Our observations show that age and BMI are associated with increased GER whereas Caucasian ethnicity and male gender are associated with increased mucosal injury from GER. Though these observations are limited by small sample size, they provide insight into strategies to minimize risk of BE in patients with GERD.
Table 1. Descriptive statistics and outcomes
Table 2. Association between distal mean nocturnal basal impedance, acid exposure time, and Barrett’s esophagus risk factors
Figure 1. Association between AET and MNBI by patient age (A), biological sex (B), race (C), ethnicity (D), smoking status (E), and BMI (F). Shaded areas represent 95% confidence intervals.
Disclosures: Christopher Toivonen indicated no relevant financial relationships. Yazan Addasi indicated no relevant financial relationships. Sirish Rao indicated no relevant financial relationships. Ryan Walters indicated no relevant financial relationships. Kalyana Nandipati indicated no relevant financial relationships. Subhash Chandra indicated no relevant financial relationships.