Barrettʼs Metaplasia and Colonic Neoplasms Coincide in Identical Patients

Abstract

Purpose: The existence of an association between Barrett's metaplasia and colonic neoplasia has remained controversial. The aim of the study was to test for the presence of such an association in a large national database. Methods: Miraca Life Sciences is a centralized pathology laboratory that serves 1,500 gastroenterologists distributed throughout the United States with more than 400,000 pathology specimens processed annually. From its computerized database, we selected 203,000 subjects who underwent colonoscopy and esophago-gastro-duodenoscopy between 1.2008 and 12.2011, with biopsy results available from both procedures. In a case-control study we compared the occurrence of Barrett's metaplasia in patients with and without various types of colonic neoplasms. Odds ratios (OR) and their 95% confidence intervals (CI) were calculated to describe the strengths of the associations between individual types of colonic neoplasms and the presence of Barrett's metaplasia. Multivariate logistic regression was used to adjust the odds ratios for age, sex, and concurrence of various histopathologic characteristics. Results: Barrett's metaplasia occurred more frequently among patients with hyperplastic polyps (OR = 2.14, 95% CI 2.02-2.27), adenomatous polyps (2.52, 2.41-2.64), advanced adenomas (2.10, 1.90-2.32), villous adenomas or adenomas with high-grade dysplasia (2.45, 2.28-2.64), and colonic adenocarcinomas (1.75, 1.39-2.22). The association between Barrett's metaplasia and colonic neoplasm applied similarly to polyps of different size, number and location within the large bowel. These types of association could also be confirmed when analyzed separately for Barrett's metaplasia characterized by low-grade or high-grade dysplasia, as well as esophageal adenocarcinoma. Conclusion: The data support the existence of a true association between Barrett's metaplasia and various types of colonic neoplasm. However, this association may be more interesting for its potential insights into the pathogenesis of the two disorders than for any clinical implication with respect to screening and surveillance of Barrett's metaplasia or colonic neoplasms. Disclosure: Dr. Genta is an employee of Miraca Life Sciences, Irving, Texas. Dr. Sonnenberg has no relevant financial relationships to disclose.