Abstract 4803: Metabolic syndrome is associated with an increased risk of Barrett's esophagus in those without symptomatic reflux.

Abstract

Abstract Background: Obesity is known to increase the propensity for gastroesophageal reflux, a discrete inflammatory effect which may lead to the development of an esophageal metaplasia termed Barrett's esophagus (BE). BE is a precancerous lesion that drastically increases the risk of esophageal adenocarcinoma. Obesity is also associated with BE independent of reflux, through unknown pathways. Metabolic syndrome (MetS) is an exposure closely aligned with obesity and represents one possible pathway. MetS produces a global inflammatory state which could increase the risk of BE. Methods: We used the SEER-Medicare linked database to evaluate the association between MetS and BE with comparison to two control groups- a general Medicare group and an endoscopy BE-negative group. MetS was defined as diagnosis of at least three of the following conditions: obesity, dyslipidemia, hypertension, and impaired fasting glucose. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (95%CI). All analyses were adjusted for age, sex, SEER registry, smoking-related conditions, Medicaid dual enrollment, reflux, and a modified Charlson comorbidity score. Results: We identified 2,212 incident Barrett's esophagus cases among 251,196 eligible beneficiaries. MetS increased the risk of BE [OR 1.20; 95%CI 1.07, 1.36] compared with Medicare controls. However, reflux status modified the association; among those without a prior reflux diagnosis, MetS was associated with a 35% increased risk of BE [OR 1.35; 95%CI 1.18, 1.55], but no association was observed among those with a history of reflux [OR 0.97; 95%CI 0.65, 1.43]. Assessment of individual components of MetS reiterated these findings. MetS was not associated with an increased risk of BE compared with endoscopy controls [OR 0.99; 95%CI 0.88, 1.10]. Conclusions: MetS was positively associated with BE; however not in a reflux population or compared to endoscopy BE-negative controls. Our findings may be explained by a saturated inflammatory state in which MetS global inflammation contributes little to the risk of BE in the presence of discrete inflammatory effects conferred by gastroesophageal reflux. Conversely, in individuals without reflux, the effects of MetS global inflammation in relation to BE are detectable. Citation Format: Jennifer Drahos, Winnie Ricker, Ruth M. Pfiffer, Joan L. Warren, Michael B. Cook. Metabolic syndrome is associated with an increased risk of Barrett's esophagus in those without symptomatic reflux. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4803. doi:10.1158/1538-7445.AM2013-4803