Sa1816 Influence of Body Mass Index (BMI) on the Prevalence of Dysplasia in Barrett's Esophagus (BE)

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Background/Aims: Increased body mass index (BMI) has been reported to be a risk factor associated with gastroesophageal reflux disease (GERD), BE and esophageal adenocarcinoma (EAC). However, it is not known if it influences the prevalence of dysplasia in BE. Our aim was to estimate the prevalence of various degrees of dysplasia in different BMI groups of patients with BE. Methods: Patients who underwent upper endoscopy and were found to have endoscopic evidence of BE confirmed by presence of intestinal metaplasia on histology from January 2000 to December 2012 at Cleveland Clinic were reviewed. Patients who had BMI values available within one year of upper endoscopy were included in the analysis. BMI levels were classified as following groups: <25, 25-27.4, 27.5-29.9, 30-34.9, 35-39.9 and ≥40. Patient demographics and endoscopic findings such as length of BE, dysplasia in BE and size of hiatal hernia were reviewed. Dysplasia was classified as no dysplasia, low grade dysplasia (LGD), high grade dysplasia (HGD) and EAC. Indefinite for dysplasia was included under LGD group. Data were presented as mean + standard deviation, Median (25th, 75th percentiles) or N (%). Jonckheere-Terpstra test was used to assess differences between the groups. Results: Among a total of 2370 patients, 1239 were included in the analysis. Mean age was 60.6 ±13 yrs. 76% were men and 94.7% were Caucasian. Average BMI was 29.8 ± 6 kg/m2. The time between EGD and BMI measurement ranged between 0-12 months with a mean of 1.3 months. There were 228 (18.4%) in group with BMI<25, 236(19%) in BMI group25-27.4, 262(21.1%) in BMI 27.5 29.9, 303 (24.5%) in BMI 3034.9, 126(10.2%) in BMI 35-39.9 and 86(6.8% ) in BMI ≥40. The mean length of Barrett's segment was 3 ± 3.4 cm and hiatal hernia size was 1.9 ±2 cm. The histological findings were no dysplasia in 732 (59.1%), LGD in 159 (12.8%), HGD in 149(12%) and EAC in 199 (16.1%) patients. Lower BMI groups had lower prevalence of dysplasia while patients in higher BMI groups had higher prevalence of dysplasia (p=0.002). These findings are presented in Table 1. Conclusions: Our study found that prevalence of degree of dysplasia varies by BMI. Increased BMI was associated with higher prevalence of dysplasia. These findings have important clinical implications since BMI is a modifiable risk factor. BMI and Degree of Dysplasia