231 Reflux Control Is an Important Component of the Management of Barrett's Esophagus – Results From a Retrospective Cohort of 1834 Patients

Abstract

Introduction: Barrett's esophagus (BE) is the most predictive risk factor for development of esophageal adenocarcinoma, a malignancy with the fastest increasing incidence rate in the US. Based on the assumption that all patients progress through low-grade dysplasia (LGD) to high-grade dysplasia (HGD) and finally to esophageal adenocarcinoma (EAC), we were interested in studying factors that may affect the rate of progression to LGD or greater. We were particularly interested in investigating the question of whether control of reflux, either surgically or medically, protects patients from progression to dysplastic disease or adenocarcinoma. Methods: We retrospectively collected and analyzed data from a cohort of BE patients participating in this single-center study comprised of all patients diagnosed with BE at a single health system's hospitals and clinics over a 10 year period. Patients were followed in order to identify those progressing from BE to LGD, HGD, and EAC. Mean follow up period was 5.4 years (9903 patient-years). We collected information from the patient's electronic medical records regarding demographic data, endoscopic findings, histological findings, smoking and alcohol history, medication use including PPI's, and history of bariatric and antireflux surgery. Risk adjusted model was performed using multivariable logistic regression in SAS 9.3 (Cary, NC). Results: This study included 1834 total BE patients, 105 of which had their BE progress to LGD, HGD, or EAC (confirmed by biopsy) with an annual incidence rate of 1.1%. Compared to the group that did not progress, the group that progressed was older (63.8±13.5 vs. 68.8±13.1. p<.001) and likely to be male (61% vs. 69%, p=0.098). In the multivariable analysis, patients who had a history of antireflux surgery (n=44) or PPI use without surgery (n=1708) were found to progress at lower rates than patients who did not have antireflux surgery or were not taking PPI's (OR=0.23, 95% CI 0.12-0.42). Conclusions: In patients with BE without dysplasia, reflux control was associated with decreased risk of progression to LGD, HGD, or EAC. The results support the use of reflux control strategies such as PPI therapy or surgery in patients with non-dysplastic BE.