*EMBARGOED All research presented at the 2019 ACG Annual Scientific Meeting and Postgraduate Course is strictly embargoed until Monday, October 28, 2019, at 8:00 am CDT.
Oral 34 Cumulative Increase in the Prevalence of Esophageal Cancer in Patients With Gastroesophageal Reflux Disease (GERD) and Multiple Risk Factors
Author Insight from Omar A. Alaber, MD, Case Western Reserve University School of Medicine
What’s new here and important for clinicians?
Esophageal adenocarcinoma (EAC) has been one of the fastest growing cancers in the Western hemisphere in recent decades. This is a malignancy that is often detected in its advanced stages and consequently, is associated with a dismal prognosis. Barrett’s esophagus (BE), which is the endoscopic and histopathologic presence of columnar lined intestinal metaplasia (IM) in the esophagus, is the only established precursor of EAC. Most, if not all EAC tends to follow the IM dysplasia EAC sequence. Early detection of BE is crucial, as this would allow for possible therapeutic prevention interventions. Recognizing the high stakes involved in detecting BE, the American College of Gastroenterology (ACG) recommends targeted screening of individuals for men with GERD and two or more risk factors (such as age > 50 years, Caucasian race, central obesity, current or past history of smoking, and confirmed family history of BE or EAC in a first degree relative).
We conducted a retrospective cohort study (using IBM Explorys Solutions, IBM, Inc.) with the goal of elucidating the risk associated with GERD and individual risk factors for the development of BE or EAC. We examined if there was an additive or cumulative effect of these risk factors in comparison to GERD alone, which served as our control population. Our analysis shows that when the number of risk factors for BE/EAC increases, there tends to be a strong incremental risk of getting diagnosed with BE or EAC (Figures 1 and 2). Our study validates the utility of the 2015 ACG Barrett’s guidelines for clinicians, not just for gastroenterologists, but also for primary care physicians who tend to see a lot of patients with these risk factors in their everyday clinical practice. Our study also underscores the need for the development and uptake of newer and more cost-effective BE screening strategies.
What do patients need to know?
Patients with long standing GERD and one or more of these risk factors need to be aware that they are at an increased risk for developing BE and EAC. Additionally, the higher the number of risk factors, greater are the chances of getting diagnosed with BE or EAC. Essentially, this study is an urgent call for a visit to the primary care physician or gastroenterologist when patients find themselves burdened with these risk factors. From a public health perspective, we hope that our study will bring more awareness among patients about modifiable risk factors such as smoking and obesity, the latter of which has become a ballooning menace in the United States.
Omar A. Alaber, MD, Case Western Reserve University School of Medicine
oaa22 [at] case [dot] edu
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