P2394 - Hiatal Hernias Predispose to the Development of Barrett’s Esophagus and Associated Dysplasia: Results From a Multicenter Electronic Health Research Network Study

Ritu Singh, MD¹, Neil Sharma, MD², Michael S. Smith, MD, MBA^3
1Indiana University Medical Center, Fort Wayne, IN; ²Parkview Medical Center, Fort Wayne, IN; ³Mount Sinai West & Mount Sinai Morningside Hospitals, New York, NY

Introduction: Barrett’s esophagus (BE) is a premalignant condition for the development of esophageal adenocarcinoma (EAC). While the annual risk of BE progression to EAC is estimated at 0.3% for non-dysplastic BE, it increases to over 6% in patients with high grade dysplasia (HGD). Hiatal hernia (HH) is one risk factor for development of BE; however, there is limited data on the relationship between the presence of HH and dysplasia within BE. The aim of this study was to determine the incidence of BE in patients with HH and to compare the prevalence of dysplasia among BE patients with and without HH.

Methods: A population-based, multi-center, retrospective cohort study was conducted utilizing TriNetX (Cambridge, MA), “a global federated health research network” of 51 healthcare organizations. The 10-year study period was 5/2011 to 5/2021. Patients ≥18 years were identified with BE (K22.7) and HH (K44) using ICD-10-CM codes. The primary outcome was the incidence of BE in patients with HH during a 5-year follow-up. Other outcomes were the presence of BE with any dysplasia, and specifically HGD, in patients with and without HH. Propensity score matching was done for baseline patient characteristics and common risk factors associated with BE as part of the analysis.

Results: A total of 729,198 HH patients and 157,831 patients with BE were identified. Among the BE patients, 54,487 also had a preceding diagnosis of HH. During a 5-year follow-up period BE developed in 6,417 of the HH patients (0.9%). Known risk factors of BE (obesity, GERD, sleep apnea) were found more commonly in the BE cohort (table 1), and were propensity-matched for analysis. Compared to BE patients without a documented HH, those with HH had a higher risk of finding any dysplasia (4.1% vs 2.7%, risk ratio (RR) 1.52, 95% CI 1.42-1.63) and HGD (1.6% vs 0.7%, RR 2.33, 95% CI 2.05-2.64). Of note, esophageal cancer was detected in 4.3% in the HH cohort compared to 2.3% in those without HH (RR 1.84, 95% CI 1.71-1.97) during 5 years of follow-up.

Discussion: This study shows that the presence of a HH is associated with an increased risk of developing any BE, including dysplastic subtypes, despite controlling for other potential risk factors. This is an interesting finding that is yet to be confirmed prospectively. HH can be detected via radiography and manometry, in addition to endoscopy. Its presence may augment the ability to risk-stratify patients for dysplastic progression, thereby improving current surveillance and eradication strategy.



Disclosures:


Ritu Singh, MD¹, Neil Sharma, MD², Michael S. Smith, MD, MBA³. P2394 - Hiatal Hernias Predispose to the Development of Barrett’s Esophagus and Associated Dysplasia: Results From a Multicenter Electronic Health Research Network Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.