Tu1542 INCREASED PREVALENCE OF BARRETT’S ESOPHAGUS IN PATIENTS WITH DUODENAL ADENOMA

Abstract

Duodenal adenomas are relatively common in patients with familial adenomatous polyposis (FAP) but sporadic duodenal adenomas are rare. Cyclooxygenase 2 (COX-2) is an important regulatory protein identified in the upper gastrointestinal adenoma-carcinoma sequence. Some studies have shown constitutive COX-2 expression in normal duodenum and esophagus and higher levels in dysplastic esophageal tissue and Barrett’s esophagus (BE). However, the prevalence of BE in patients with duodenal adenomas has not been described. A retrospective cross-sectional study was performed using our electronic endoscopy and pathology database. Study subjects included all patients with duodenal adenoma at our tertiary care academic medical center from Sept 2009 to Sept 2018. Data regarding patient demographics, comorbid conditions and medication use was noted. We also collected information regarding endoscopic and histological findings. A total of 333 patients with duodenal adenoma were included in the study. The average age was 71.6 years and 50.1% were females. A total of 13% of patients had FAP. Barrett’s esophagus was identified in 32 patients (9.6%). There was no difference in patient characteristics amongst patients with duodenal adenoma who had BE as compared to those who did not [Table 1]. As compared to the general population, 43.7% of duodenal adenoma patients who had BE were female. In patients with duodenal adenoma, patients on proton pump inhibitor (PPI) therapy have higher Barrett’s esophagus 15.2% vs 3.2% (p value 0.001). On a multivariate analysis patients with duodenal adenoma not using PPI have significantly lower Barrett’s esophagus [OR=0.14, ( 95% CI: 0.04- 0.52, p-value: 0.003] Despite our study limitations of referral bias and a single center experience, our findings demonstrate that 1 in 10 patients with duodenal adenoma have concomitant Barrett’s esophagus. The prevalence of Barrett’s esophagus in patients with duodenal adenoma is higher than in the general population. Previously some reports have shown changes in expression of some cell regularity proteins such as COX-2 in patients with duodenal adenomas, and COX-2 has also been reported to be increased in BE. Further studies are needed evaluating molecular characteristics in these patients to see if this finding has any clinical significance.