Mo1117 Atrophic Autoimmune Gastritis: Manifestations and Clinicopathologic Associations in a Large United States Cohort

Abstract

Background: Statins have been associated with a reduced risk of esophageal adenocarcinoma, however their possible effect on the risk of developing Barrett's esophagus (BE) is unknown. This study evaluated the association between statin use and the risk of BE. Methods: We conducted a case-control study among eligible patients scheduled for elective esophagogastroduodenoscopy (EGD) and a sample of patients eligible for screening colonoscopy recruited from primary care clinics at a single VA center. We compared 303 patients with definitive BE with two separate frequency matched control groups: 303 patients from the primary care group (primary care controls) and 606 patients from the elective EGD group (endoscopy controls) with no endoscopic or histopathologic BE. Index date was the earliest BE diagnosis date for cases, and the study EGD date for controls. Use of statins and other lipid lowering medications was ascertained by reviewing filled prescriptions in electronic pharmacy records during a 10-year period before index date, and use before the index date was compared between cases and controls. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) using multivariable logistic regression models adjusting for age, sex, race, GERD symptoms, H. pylori infection, and waist-to-hip ratio (WHR). Results: Most in the cohort were men (97.7%) and white (75.5%). Dispensed prescriptions for statins were identified in 64.6% of subjects, most of whom (94.3%) used simvastatin. The proportion of BE cases (57.4%) with filled statin prescriptions was significantly less than in endoscopy controls (64.9%; p=0.029) and primary care controls (71.3%; p<0.001). Most of the difference was related to a higher proportion of controls having statin prescriptions that were first filled earlier than 5 years before the index date than cases (p=0.001) and prescriptions that lasted for 3-10 years (33.9% vs. 28.1%; p=0.011). Longer durations of statin prescriptions were filled by the combined groups of control subjects than BE cases; mean duration (28.6 months vs. 22.1 months, p=0.001). In multivariable analysis, statin use significantly reduced the risk of BE (adjusted OR, 0.70; 95% CI, 0.52-0.93) compared with the combined control groups. The risk of BE is particularly lower with statin use among patients who were obese (OR, 0.49; 95% CI, 0.31-0.78), or had a high WHR (OR, 0.65; 95% CI, 0.48-0.89). Importantly, we found no significant association between BE and non-statin lipid lowering medications (p=0.452). Most study subjects (91.3%) reported the VA as the primary source for most medications, and 84.6% reported receiving all prescriptions from the VA pharmacy with no significant differences between cases and controls (p=0.618). Conclusion: Statin usemay decrease the risk for BE, especially among patients who are obese or have a highWHR.