Motasem Alkhayyat, MD1, Mohammad Abureesh, MD2, Mohannad Abou Saleh, MD1, Thabet Qapaja, MD1, Ashraf Almomani, MD1, Sara El Ouali, MD1, Emad Mansoor, MD3, Adrian Lindsey, MD3, Mythri Anil Kumar, MD4, Miguel Regueiro, MD1; 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: Few studies have shown an association between Crohn’s disease (CD) and Barrett’s esophagus (BE). Limited data are available regarding the effects of CD treatments on developing BE. Using a large database, we sought to describe the epidemiology and risk of BE among CD patients and the effect of different CD treatments on that risk. Methods: We queried a commercial 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 CD between 2016-2020 was identified. The rates of new diagnoses of BE and esophageal carcinoma after at least 30 days were calculated. Age, gender and race based distributions were described and underlying associations were analyzed. 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, 181,670 had CD (0.46%). The prevalence of patients with new diagnosis of BE as well as EC after at least 30 days of CD was 1.29% and 0.14% respectively, compared to 0.53% and 0.07% respectively in non-CD patients. Compared to the general population, patients with CD had higher association risk of BE [OR: 3.68; 95% CI: 3.56-3.81] as well as esophageal cancer [2.29( 95% CI 2.02-2.59)]. Among CD patients, predictors of having BE were age >65 years, male gender, Caucasian race and obesity (Table 1). Among CD patients, those who received Anti-TNFs [0.85 (0.77-0.94), ustekinumab [0.50 (0.35-0.71)], azathioprine [0.79 (0.70-0.90)], and 6-MP [0.78 (0.65-0.93)] treatment had lower risk of BE whereas 5ASAs [1.56 (1.45-1.67)] had a higher risk (Table 2). Patients with CD had a statistically insignificant lower rates of EC, while methotrexate was associated with higher risk of EC [4.16 (2.96-5.83)]. Discussion: In this large database, we found a higher risk association between CD and BE as well as EC. Conversely, CD patients treated with anti-TNFs, ustekinumab or thiopurines had lower risk of developing BE. Interestingly, methotrexate was associated with higher rates of EC. Further studies are required to better understand the association of CD and BE and determine if immunosuppressive treatment is protective against BE.
Table 1: Predictors of Developing Barrett’s Esophagus and Esophageal Cancer Among Crohn’s Disease
Table 2: Effect of Different IBD Treatments on Risk Association with Development of Barrett’s Esophagus and Esophageal Cancer
Disclosures: Motasem Alkhayyat indicated no relevant financial relationships. Mohammad Abureesh indicated no relevant financial relationships. Mohannad Abou Saleh indicated no relevant financial relationships. Thabet Qapaja indicated no relevant financial relationships. Ashraf Almomani indicated no relevant financial relationships. Sara El Ouali indicated no relevant financial relationships. Emad Mansoor indicated no relevant financial relationships. Adrian Lindsey indicated no relevant financial relationships. Mythri Anil Kumar indicated no relevant financial relationships. Miguel Regueiro indicated no relevant financial relationships.