Change in Serum 25-Hydroxy Vitamin D Levels Do Not Impact Progression of Dysplasia in Barrett’s Esophagus (BE)

Abstract

Introduction: Vitamin D may have a potential role in chemoprevention of esophageal adenocarcinoma (EAC) if it can delay the progression of dysplasia in BE. Studies showing protective association between high concentrations of vitamin D and EAC are equivocal.To date, there are no reported studies that investigated association between Vitamin D levels and the risk of progression in BE to EAC. Our aim was to see if higher serum levels of 25-hydroxy Vitamin D (25(OH)D) were associated with lower risk of progression in BE. Methods: Patients with BE seen in our department from January 2000 to December 2012 who had serum 25(OH)D levels measured were included. Demographics such as age, gender, race, BMI, Vitamin D levels and endoscopic findings such as BE length, hiatal hernia size, and biopsy findings were recorded. Exclusion criteria were high grade dysplasia ( HGD) or EAC at baseline biopsy, lack of data regarding follow up serum 25(OH)D levels or biopsies. Progression is defined as worsening grade of dysplasia or development of EAC. Results: A total of 158 patients met the inclusion criteria, 128 in no dysplasia group and 30 in low grade dysplasia (LGD) group. Median follow-up time was 42 [20.9, 86.9] months. In non-dysplastic group, there were 20 cases of LGD, 3 cases of HGD and 3 cases of cancer during follow-up. In LGD group, 4 progressed to HGD. None developed EAC in LGD group. There was no significant difference in terms of age, gender, race, BMI, 25(OH) D levels between progressors and non progressors (Table 1). Similarly, change in serum 25(OH) D levels was not found to impact progression to dysplasia/ EAC by multivariable analysis.Table 1: Progression to HGD / EACConclusion: There is no evidence to suggest that baseline serum 25(OH) D levels or change in the levels are associated with progression to dysplasia or EAC in BE patients. Vitamin D might not have a role as a chemopreventive agent for EAC.