Case Western Reserve University, Metrohealth Medical Center Cleveland, OH
Award: Presidential Poster Award
Sara Ghoneim, MD1, Fahmi Shibli, MD2, Muhammad U. Butt, MD, MS1, Ronnie Fass, MD, FACG2; 1Case Western Reserve University, Metrohealth Medical Center, Cleveland, OH; 2MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
Introduction: Barrett's esophagus (BE) is seen in15% of patients with chronic GERD (cGERD). Little is known about the risk of BE in hypercontractile disorders. BE is reported in up to 14% of patients with treated achalasia but less commonly in those with untreated achalasia. DES is defined as premature contractions during at least 20% of swallows in conjunction with normal lower esophageal sphincter relaxation. Patients with DES are often mistakenly treated for GERD. We aim to assess the risk of BE in patients with DES compared to those with achalasia.
Methods: We used a large commercial database (Explorys, IBM) that provided electronic health records of patients from 26 major integrated US healthcare systems for 1999- 2019. Only adult subjects who underwent esophageal manometry and upper endoscopy were included. Gender, cGERD, achalasia, DES, BE, smoking and obesity were included. A univariate binary logistic model was constructed using BE as dependent variable and other variables as independent variables. To adjust for possible confounding, a multivariable model adjusting for all covariates mentioned in univariate variables were added to test the main effect along with the conditional effect of DES using the interaction with cGERD. Results: Out of 39,550 patients, 4,020 had BE (10.16%). In univariate analysis, the presence of achalasia was associated with a reduced prevalence of BE (3.97.% vs 11.17%, OR 0.33 [95%CI: 0.28–0.37]). There was a slight decrease in the prevalence of BE in those with DES compared to without, but results weren't statistically significant (9.74% vs 10.27%, OR 0.94 [0.86–1.02]). There was a higher prevalence of BE seen in obese BMIcompared to non-obese (11.98% vs 9.79%, OR 1.25 [1.16–1.36]). There was a higher prevalence of BE in those with cGERD compared to no cGERD (11.42% vs 2.78 %, OR 4.51 [3.84–5.30]) when the gender was male (13.38.% vs 8.53 %,OR 1.66 [1.55–1.77]), and in smokers (17.38.% vs 8.27%, OR 2.33 [2.18–2.50]). In multivariate model, adjusted odds of prevalence remained higher in males (OR 1.74 [1.62–1.87]), obese (OR 1.06 [1–1.16]) smokers (OR 2.15 [2–2.3]) and lower in those with achalasia (OR 0.35 [0.30-0.40]). The presence of cGERD was strongly associated with BE, but effect was modified by DES. If DES is present with cGERD then odds of prevalence were much higher (OR 9.90 [5.28–18.57]) compared to if cGERD was present alone (OR 3.39 [2.86–4.01]). Discussion: The combination of cGERD and DES results in triple the risk for BE as compared to GERD alone.
Table 1: Baseline characteristics of study population. Abbreviation: cGERD: chronic gastroesophageal reflux disease; DES: diffuse esophageal spasm.
Table 2: Multivariate regression analysis using BE as the dependent variable. *All p-values < 0.001 unless otherwise specified. **Using the interaction between DES and cGERD. Abbreviation: BE: Barrett's esophagus; cGERD: chronic gastroesophageal reflux disease; DES: diffuse esophageal spasm.
Figure 3. Forrest plot showing the adjusted odds ratio for having BE. In the presence of DES, the adjusted odds of having BE is tripled in patients with GERD. Abbreviation: BE: Barrett's esophagus; cGERD: chronic gastroesophageal reflux disease; DES: diffuse esophageal spasm.
Disclosures: Sara Ghoneim indicated no relevant financial relationships. Fahmi Shibli indicated no relevant financial relationships. Muhammad Butt indicated no relevant financial relationships. Ronnie Fass: Astrazenec – Other Financial or Material Support, Speaking and Teaching. Cadilla – Other Financial or Material Support, Speaking and Teaching. Chinoin – Consultant. Eisai – Other Financial or Material Support, Speaking and Teaching. Takeda – Other Financial or Material Support, Advisory Committees or Review Panels; Speaking and Teaching.