Systematic reviews and meta-analyses
Factors Associated With Progression of Barrett’s Esophagus: A Systematic Review and Meta-analysis

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Background & Aims

Endoscopic surveillance of patients with Barrett’s esophagus (BE) is inefficient. Risk stratification of patients might improve the effectiveness of surveillance. We performed a systematic review and meta-analysis to identify factors associated with progression of BE without dysplasia or BE with low-grade dysplasia (LGD) to high-grade dysplasia or esophageal adenocarcinoma.

Methods

We performed a systematic search of databases through May 2016 to identify cohort studies of patients with baseline BE without dysplasia or BE with LGD that reported predictors of progression. Pooled estimates (odds ratios) of associations of age, sex, smoking, alcohol use, obesity, baseline LGD, segment length, and medication use with progression were calculated.

Results

We identified 20 studies, reporting 1231 events in 74943 patients. The studies associated BE progression with increasing age (12 studies; odds ratio [OR], 1.03; 95% CI, 1.01–1.05), male sex (11 studies; OR, 2.16; 95% CI, 1.84–2.53), ever smoking (current or past, 8 studies; OR, 1.47; 95% CI, 1.09–1.98), and increasing BE segment length (10 studies; OR, 1.25; 95% CI, 1.16–1.36), with a low degree of heterogeneity. LGD was associated with a 4-fold increase in risk of BE progression (11 studies; OR, 4.25; 95% CI, 2.58–7.0). Use of proton pump inhibitors (4 studies; OR, 0.55; 95% CI, 0.32–0.96) or statins (3 studies; OR, 0.48; 95% CI, 0.31–0.73) were associated with lower risk of BE progression. Alcohol use and obesity did not associate with risk of progression.

Conclusions

In a systematic review and meta-analysis, we associated older age, male sex, smoking, longer BE segment, and LGD with risk of progression of BE. Individuals with these features should undergo more intensive surveillance or endoscopic therapy. Smoking is a modifiable risk factor for cancer prevention in patients with BE.

Section snippets

Methods

This systematic review was performed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions.21 It is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.22 A priori established protocol was followed.

Results

From a total of 2522 studies identified by our search strategy, 30 independent cohort studies that directly reported OR provided sufficient data to calculate OR between variables of interest and progression to HGD/EAC and were included in the analysis.9, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43 Six studies were excluded because of overlapping populations.3, 18, 44, 45, 46, 47 Four studies were excluded because they reported outcomes in patients with baseline

Discussion

Several studies have tried to identify factors that predict malignant progression in BE subjects to risk stratify BE subjects but the results have not been consistent across studies. The current systematic review and meta-analysis identifies demographic factors, lifestyle factors, BE-related characteristics, and medications that had significant associations with the risk of progression to HGD/EAC in BE subjects without dysplasia or with LGD.

Acknowledgments

The authors thank Mr. Larry Prokop, Medical Librarian at the Mayo Clinic Library, for helping in the literature search for this systematic review and meta-analysis.

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    Conflicts of interest The authors disclose no conflicts.

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