Correlation Between Traditional Barrett's Esophagus Risk Factors and Gastroesophageal Acid Reflux and Esophageal Mucosal Injury

Abstract

Introduction: Repeated mucosal injury from gastroesophageal reflux (GER) causes Barrett’s esophagus (BE). We studied correlation between traditional BE risk factors and the degree of gastroesophageal acid reflux and mucosal injury. Methods: Consecutive adults who underwent pH-impedance monitoring off therapy between Oct 2013-March 2020 were included. Patients with major motility disorders were excluded. Acid exposure time (AET) was used to determine the degree of gastroesophageal acid reflux. Mucosal injury was assessed using distal mean nocturnal basal impedance (dMNBI) which measures increased mucosal permeability from reflux injury. The correlations were assessed on univariable and multivariable linear regression models. Results: After excluding 33 for major motility disorder, 219 patients were included. On multivariate model, older age (p=0.038), White race (p=0.005), and higher BMI (p=0.015) had positive correlation with AET, while sex (p=0.154) and smoking (p=0.193) were not. Non-white patients averaged 50% (95%CI, 20-70%) lower AET, AET increased with age up to 60 years and with BMI up to 33 kg/m 2 . Inverse correlation observed between dMNBI and all the risk factors and AET. On multivariate analysis, only AET (p<.001) had significant correlation with dMNBI, male sex had borderline correlation (p=0.052) and none with age (p=0.140), race (p=0.117), smoking status (p=0.461), and BMI (p=0.109). Conclusion: Differential mucosal injury from GER noted between different BE risk factors; age, obesity, and White race increase degree of acid reflux, while male sex likely has higher degree of injury from acid reflux. These observations are insightful in developing a strategy to mitigate BE risk. Funding Statement: None. Declaration of Interests: None. Ethics Approval Statement: This study was approved by the Creighton University Institutional Review Board.