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Diabetes May Increase Esophageal Cancer Risk

Patients with Barrett’s esophagus who also have diabetes are at increased risk for the esophageal disease to progress to dysplasia or cancer…. 

From preliminary data presented at the ACG conference on October 13, 2013, researchers found that diabetic patients with Barrett’s Esophagus are at increased risk for the esophageal disease to progress to dysplasia or cancer. However, the opposite was the case for hypertension. The authors analyzed data from a cohort of 1,623 patients with Barrett’s esophagus seen between December 2000 and March 2013. A total of 274 patients either had, or were diagnosed with diabetes during the study period.

Patients with diabetes were older (64 versus 59.6 years, P<0.001) and were more likely to be hypertensive (81.4% versus 33.8%, P<0.001). No significant differences were seen for sex (P=0.13), race (P=0.099), length of the Barrett’s esophagus segment (P=0.53), or size of hiatal hernia (P=0.17). However, higher rates of those without diabetes showed no evidence of dysplasia on initial endoscopy (62.3% versus 55.5%, P=0.004). On the biopsy no dysplasia was found in 56.9% of those without diabetes and in 51.5% of those with diabetes, while adenocarcinoma was found in 15.8% of those without diabetes and in 25.9% of those with diabetes (P<0.001). Progression to high-grade dysplasia or cancer was seen in almost twice as many patients with diabetes (17.9% versus 9.7%, P=0.018).

The authors also examined the effect of hypertension to the risk of progression in their Barrett’s cohort. Of the patients included in the study, 41% had hypertension and 32.8% of those had diabetes. Among those who were normotensive, 5.4% had diabetes. Those who had hypertension were older, averaging 63.9 at the time of Barrett’s diagnosis compared with 57.9 among those without elevated blood pressure. Length of the Barrett’s segments was longer in those without hypertension (3.3 cm versus 2.7 cm, P=0.003), but no differences were seen in sex (P=0.55), race (P=0.067) or hernia size (P=0.78). During 17.6 months of follow-up, 61.9% of patients with hypertension had no dysplasia, compared with 56% of patients without hypertension throughout 14.6 months of follow-up (P=0.02). A total of 10.9% and 10% of those with hypertension developed low- and high-grade dysplasia, respectively, as did 15% and 12.6% of those who were normotensive, while 16.3% of patients with hypertension developed adenocarcinoma as did 17.2% of those without hypertension.

Although these results are from preliminary data, the finding that hypertensive patients had a twofold lower risk for progression was unexpected. This is mainly due to the increased risk of Barrett’s Esophagus in hypertensive individuals. Further research in this area is warranted.

Practice Pearls:
  • Hypertensive patients had a twofold lower risk for progression of Barrett’s esophagus.
  • On the biopsy no dysplasia was found in 56.9% of those without diabetes and in 51.5% of those with diabetes.
  • Adenocarcinoma was found in 15.8% of those without diabetes and in 25.9% of those with diabetes.

American College of Gastroenterology, ACG Poster P1, October 2013