National Database Study Finds Higher Risk for Barrett’s Esophagus in IBD

ORLANDO – People with inflammatory bowel disease (IBD) faced higher odds of Barrett’s esophagus (BE) and BE without dysplasia, but not BE-linked malignancy, according to a cross-sectional study.

Among patients diagnosed with ulcerative colitis (UC), the prevalence of BE was 0.077%, while the prevalence of BE in patients with Crohn’s disease (CD) came in at 0.63%, and the prevalence of BE among hospitalized patients without IBD was 0.40% (P<0.05), reported Nilay Bhatt, MD, of Merit Health Wesley in Hattiesburg, Mississippi.

The prevalence for BE-associated malignancy for UC was 0.08% versus 0.03% for CD versus 0.13% for non-IBD, Bhatt and colleagues stated in a poster at the Advances in Inflammatory Bowel Diseases annual meeting.

“We were able to establish that there were some associations between IBD and the likelihood of a Barrett’s esophagus diagnosis, but there was no evidence of a causative relationship in either direction,” Bhatt told MedPage Today. The researchers are continuing to analyze the data to see if causality can be established, he added.

Bhatt suggested that IBD and BE might both be related to autoimmune issues, and both diseases haves ties to environmental issues, such as eating spicy foods or smoking or alcohol abuse. Additionally, one of the illnesses might be causing the other, or the same genetic and environmental issues might be independently related to the development of both diseases, he noted.

Bhatt said his group’s study may indicate that BE should be included in an IBD work-up and vice versa. “What is crucial, is that early diagnosis can reduce the burden of Barrett’s esophagus because quite often we don’t diagnose Barrett’s esophagus until it is late in the disease process and there is already dysplasia, which, of course, is a precursor to esophageal cancer,” he said.

Suprada Vinyak, MD, of Ballad Health in Norton, Virginia, reiterated to MedPage Today that the data showed associations between IBD and BE, and called it “an important finding.” But Vinyak, who was not involved in the study, cautioned that “whether one condition causes the other is still not known, and further research is going to be needed to sort that out.”

The researchers accessed the Healthcare Cost and Utilization Project’s National Inpatient Sample (NIS), the largest all-payer inpatient care database in the U.S. with information on >7 million hospital stays. They evaluated records from 930,280 patients diagnosed with IBD (n=346,515 with UC; n=583,0765 with CD).

The researchers found that those ages 51-75 with IBD were 2.26 times more likely to develop BE compared with non-IBD patients in the hospital. Those with IBD who were ages >75 had a 1.99-fold increased risk of having BE versus those without.

Bhatt also said that compared to the non-IBD population, the BE risk was increased among the following with IBD:

• Women: 58%
• Smokers: 39%
• People with hypertension: 29%
• People with hyperlipidemia: 34%

Study limitations included the fact that only inpatient data were analyzed. Also, there was a lack of long-term follow-up data.

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