Motasem Alkhayyat, MD1, Mohannad Abou Saleh, MD1, Mohammad Abureesh, MD2, Thabet Qapaja, MD1, Krishna Sanaka1, Ashraf Almomani, MD1, Adrian Lindsey, MD3, Mythri Anil Kumar, MD4; 1Cleveland Clinic Foundation, Cleveland, OH; 2Staten Island University Hospital, New York City, NY; 3University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH; 4Cleveland Clinic Foundation, Hartford, CT
Introduction: Barrett’s esophagus (BE) and colorectal cancer (CRC) share similar risk factors. Previous studies have shown variable prevalence of colonic polyps and CRC in patients with BE. Using a large multi-center database, we sought to describe the risk and predictors of colonic polyps and CRC among BE patients. Methods: We queried a multi-institutional database (Explorys Inc, Cleveland, OH, USA); an aggregate of electronic health record data from 26 US healthcare systems. A cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of “Barrett’s Esophagus” 2016-2020, who underwent an upper endoscopy and colonoscopy was identified. Subsequently, another cohort of those who developed colonic polyps and Colorectal cancer was identified. Patients < 18 years old, history of inflammatory bowel disease, familial colorectal cancer syndromes, and familial polyposis syndromes were excluded. Cases were controlled with patients who underwent upper endoscopy and colonoscopy with no history of BE. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS version 25, IBM Corp). For all analyses, a 2-sided P value of < 0.05 was considered statistically significant. Results: Of the 39,328,760 individuals in the database, 3,665,190 (9.3%) underwent both an upper endoscopy and a colonoscopy. Among 89,210 (2.4%) individuals with history of BE, 25.3% had colonic polyps and 2.5% had CRC compared to 14.6% and 2.1% respectively in the control group, P< 0.0001. Baseline characteristics of cases and controls are shown in Table 1. Compared to the general population, patients with BE had higher association risk of colonic polyps [OR: 2.05 (2.02-2.08), P< 0.0001] as well as CRC [OR: 1.20 (1.16-1.24), P< 0.0001]. Among BE patients, predictors of having colonic polyps or CRC were age > 65 years, male gender, history of smoking, diabetes, and hyperlipidemia (Table 2). Discussion: In this large database, we found that BE patients have a two-fold increased risk of colonic polyps and a modest increased risk of CRC. This has important clinical implications for colon screening and surveillance in BE patients.
Table 1: Baseline Characteristics of Cases and Control Groups. GERD; gastroesophageal reflux disease, PPI; proton pump inhibitors, H2-Blocker; histamine receptor blocker
Disclosures: Motasem Alkhayyat indicated no relevant financial relationships. Mohannad Abou Saleh indicated no relevant financial relationships. Mohammad Abureesh indicated no relevant financial relationships. Thabet Qapaja indicated no relevant financial relationships. Krishna Sanaka indicated no relevant financial relationships. Ashraf Almomani indicated no relevant financial relationships. Adrian Lindsey indicated no relevant financial relationships. Mythri Anil Kumar indicated no relevant financial relationships.