Barrett’s Esophagus Risk Increase with Diabetes

Diabetes patients are at risk regardless of presence or absence of other risk factors…. 

According to a recently published study, patients with diabetes are at an increased likelihood for developing Barrett’s esophagus. This risk is associated regardless of whether or not the patient has other risk factors such as tobacco use, gastroesophageal reflux disease (GERD), and obesity.

Researchers conducted a population-based case-control study, evaluating data on 14,245 patients with Barrett’s esophagus and 70,361 matched controls. The data was drawn from the General Practice Research Database. The incidence of type 2 diabetes diagnosis prior to Barrett’s esophagus was defined as a baseline diagnosis along with a medication code that indicated that insulin or an oral hypoglycemic prescription was filled prior to the initial Barrett’s esophagus diagnosis. This was then recorded and compared between the groups.

Prior type 2 diabetes diagnosis was seen more often in the experimental group with Barrett’s esophagus when compared to the controls (5.8% versus 5.3% respectively: OR=1.1, 95% CI, 1.02-1.19). When analyzing for only a type 2 diabetes diagnosis as opposed to a prior diagnosis, results yielded a numerically but nonsignificantly higher rate of 7.48% in the Barrett’s esophagus group versus 7.07% among the controls.

Adjusting for confounders such as smoking, obesity and GERD diagnosis at baseline, a multivariate analysis showed an association that was independent between Barrett’s esophagus and prior type 2 diabetes diagnosis (OR=1.49, 1.16-1.91). When analyzing all type 2 diabetes diagnosis (n=12,511 cases and 52,140 controls), the association was reduced but it was still significant (OR=1.27, 1.04-1.55). The research team pointed out that the association was more defined among females (OR=1.41, 0.982-2.017 compared with OR=1.13, 0.865-1.477) (95% CI for all).

When the research team analyzed the data with Barrett’s esophagus being defined as the presence of two or more Barrett’s esophagus diagnostic codes with an endoscopy code following initial diagnosis (n=1,170 cases and 4,834 controls), there was an even stronger association between type 2 diabetes and Barrett’s esophagus risk (OR=4.24, 1.39-12.91). When Barrett’s esophagus was defined as only two or more diagnostic codes following initial diagnosis (n=5,664 cases and 23,109 controls) the association was insignificant (OR=1.35, 0.87-2.09) (95% CI for both).

"DM2 was found to be a risk factor for BE, independent of smoking, obesity … and a diagnosis of gastroesophageal reflux," the researchers wrote. "Patients with DM2 may be at a higher risk of developing BE and, potentially, esophageal adenocarcinoma. Prospective studies are needed to confirm this association."

Clinical Gastroenterology and Hepatology, Volume 11, Issue 9 , Pages 1108-1114.e5, September 2013