P2393 - Patients With Gastroparesis Are More Likely to Develop Barrett’s Esophagus in the Setting of Gastroesophageal Reflux Disease (GERD) With Esophagitis: A Multicenter Electronic Health Research Network Study

Tuesday, October 26, 2021

10:30 AM – 4:00 PM PT

Location: Shoreline Exhibit Hall

Presenting Author(s)

Ritu Singh, MD

Indiana University Medical Center
Fort Wayne, IN, United States

Ritu Singh, MD¹, Neil Sharma, MD², Michael S. Smith, MD, MBA³
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 of the esophagus resulting from ongoing exposure to gastric acid and other caustic substances via gastroesophageal reflux disease (GERD). Gastroparesis is known to facilitate GERD. There is limited data on the prevalence of gastroparesis in BE patients. The aim of this study was to determine BE incidence in patients who have GERD with esophagitis in the setting of gastroparesis.

Methods: This retrospective, multicenter cohort study utilized TriNetX (Cambridge, MA), “a global federated health research network”. The platform was searched to obtain aggregated health records from around 70 million patients in 49 healthcare organizations from 5/2011 through 4/2021. Adult patients (≥18 years) who had GERD with esophagitis were identified using appropriate ICD-10 CM codes (K21.0). Within this cohort, patients were queried for a diagnosis of gastroparesis as well as a history of gastric emptying scintigraphy (GES) testing. This cohort was compared to patients with GERD and esophagitis but no known gastroparesis. The primary outcome was diagnosis of BE within a 5-year follow-up period. Propensity score matching was performed for baseline characteristics and common comorbidities. Risk ratio (RR) and risk difference (RD) were calculated and Kaplan-Maier analysis with a survival curve was obtained for primary outcomes.

Results: A total of 448,192 adult patients were diagnosed with GERD and esophagitis during the study period; 5,322 (1.2%) also had a diagnosis of gastroparesis by GES. Patients with gastroparesis were younger and were more frequently women, and Black than their counterparts, and were more likely to have hiatal hernia and other comorbidities (Table 1). During the 5-year period, 8.1% of gastroparesis patients with GERD and esophagitis developed BE compared to 4.4% of non-gastroparetics (RR= 1.86, RD= 3.76%; p< .001). There was no significant difference in the incidence of esophageal adenocarcinoma (EAC), which was seen in less than 1% of patients in each cohort.

Discussion: Our study demonstrates an increased risk of developing BE for patients with GERD and esophagitis who also have gastroparesis. While the risk of developing EAC was no different between the cohorts, it may be due to a limited 5-year follow up time. This study suggests gastroparesis should be considered as a risk factor when deciding whether to perform endoscopic screening for BE.

	Before matching					After matching
Demographics	Mean (± SD)		Number of patients (%)		P-value	Mean ± SD		Number of patients (%)		P-value
Demographics	Gastroparesis	No Gastroparesis	Gastroparesis	No Gastroparesis	P-value	Gastroparesis	No Gastroparesis	Gastroparesis	No Gastroparesis	P-value
Age (years)	51.6±15.8	54.9±17.1	5,322 (100%)	433,281 (100%)	< .001	51.6±15.8	51.9±15.7	5,313 (100%)	5,313 (100%)	.33
Female	-	-	3,853(72.4%)	247,537 (57.1%)	< .001	-	-	1,267 (45.4%)	1,265 (45.3%)	.95
Black	-	-	883 (16.6%	41,062 (9.5%	< .001	-	-	881 (16.6%	881 (16.2%	.63
Diagnoses
Diaphragmatic hernia			2100 (39.5%)	40,069 (9.2%)	< .001
Diabetes mellitus			2,331 (43.8%)	62,882 (14.5%)	< .001			2,322 (43.7%)	2,327 (43.8%)	.92
Obesity			1,848 (34.7%)	69,802 (16.1%)	< .001			1,843 (34.7%)	1,863 (35.6%)	.68
Obstructive sleep apnea			1,141 (21.4%)	34,954 (8.1%)	< .001			1,133 (21.3%)	1,126(21.2%)	0.87
Chronic kidney disease			975 (18.3%)	27,851 (6.4%)	< .001			967 (18.2%)	985 (18.5%)	.65
Malnutrition			575 (10.8%)	9,182 (2.1%)	< .001			566 (10.7%)	579 (10.9%)	0.68
Chronic pancreatitis			249 (4.7%)	3,666 (0.8%)	< .001
Cirrhosis			204 (3.8%)	8,448 (1.9%)	< .001			202 (3.8%)	194 (3.6%)	.68
Tobacco use			359 (6.7%)	12,759 (2.9%)	< .001
Procedures
Laparoscopic esophageal			310 (5.8%)	1,311 (0.3%)	< .001
Pyloroplasty			10 (0.2%)	14 (0.003%)

SD standard deviation

Table: Table 1. Baseline Characteristics Before and After Propensity Score Matching.

Disclosures:

Ritu Singh indicated no relevant financial relationships.

Neil Sharma: Boston scientific – Consultant. MedTronic – Advisory Committee/Board Member, Consultant. Mina kea – Consultant.

Michael Smith indicated no relevant financial relationships.

Ritu Singh, MD¹, Neil Sharma, MD², Michael S. Smith, MD, MBA³. P2393 - Patients With Gastroparesis Are More Likely to Develop Barrett’s Esophagus in the Setting of Gastroesophageal Reflux Disease (GERD) With Esophagitis: A Multicenter Electronic Health Research Network Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.