Motasem Alkhayyat, MD1, Mohannad Abou Saleh, MD1, Mohammad Abureesh, MD2, Ashraf Almomani, MD1, Thabet Qapaja, MD1, Mythri Anil Kumar, MD3; 1Cleveland Clinic Foundation, Cleveland, OH; 2Staten Island University Hospital, New York City, NY; 3Cleveland Clinic Foundation, Hartford, CT
Introduction: Gastroesophageal reflux disease (GERD) is highly prevalent in cystic fibrosis (CF) patients and manifests at early age of life. Barrett’s esophagus (BE) is a metaplastic transformation of the esophageal lining that predisposes to esophageal cancer (EC). Using a large multi-center database, we sought to describe the epidemiology and risk of BE and EC in CF 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 “cystic fibrosis” 2016-2020 was identified. Subsequently, another cohort of those who developed BE and EC after at least 30 days of CF diagnosis was identified. 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, 14,390 had CF (0.04%). Baseline characteristics of study and control (no CF) groups are shown in Table 1. The prevalence of patients with new diagnosis of BE and EC after at least 30 days of CF was 1.29% and 0.07% respectively. Compared to the general population, patients with CF had higher risk of BE diagnosis [OR: 1.95; 95% CI: 1.66-2.29, P< 0.0001] as well as EC [OR: 2.99; 95% CI: 1.93-4.65, P< 0.0001]. Among CF patients, predictors of having BE were male gender, and Caucasian race, history of GERD, hiatal hernia, smoking, alcohol abuse, obesity, and metabolic syndrome (Table 2). Discussion: In this large database, we found that CF patients have a two-fold increased risk of BE and three-fold increased risk of EC. Further prospective studies are required to validate these findings as it has important clinical implications for screening and surveillance in CF patients.
Table 1: Baseline Characteristics of Patients with Cystic Fibrosis and Control Group. GERD; gastroesophageal reflux disease, PPI; proton pump inhibitors; H2-blockers; histamine receptor blocker, BE; Barrett's esophagus
Table 2: Overall Risk and Predictors of Developing Barrett’s Esophagus Among Cystic Fibrosis. GERD; gastroesophageal reflux disease
Disclosures: Motasem Alkhayyat indicated no relevant financial relationships. Mohannad Abou Saleh indicated no relevant financial relationships. Mohammad Abureesh indicated no relevant financial relationships. Ashraf Almomani indicated no relevant financial relationships. Thabet Qapaja indicated no relevant financial relationships. Mythri Anil Kumar indicated no relevant financial relationships.