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Reflux Medical-Metabolic: Diabetes positively associates with Barrett‘s esophagus.

15.03.2012 by Reflux Medical

Reflux Medical
Endoscopically visible columnar lined esophagus. Image obtained during the Endoscopy of a person with GERD symptoms.

Barrett‘s esophagus is positively linked to diabetes, male gender, age > 55 years, NSAID/ASA use. Implications for screening and therapy.

Barrett‘s esophagus in Latinos undergoing Endoscopy for gastroesphageal Reflux disease symptoms.

Keyashian K, Hua V, Kline M, Chandrasoma PT, Kim JJ.
Dis Esoph 2012, ahead of print.

Barrett‘s esophagus, this is columnar lined esophagus with intestinal metaplasia, results from gastroesophageal Reflux. Via low and high grade Dysplasia non dysplastic Barrett‘s esophagus may progress towards esophageal cancer (0.5% annual risk). The diagnosis is established by the histopathology of biopsies obtained form the distal esophagus during Endoscopy.

The present study coming form the well known group around the US american pathologist Para Chandrasoma (=inventor of the Chandrasoma classification, described in iGERD), examined the frequency of Barrett‘s esophagus in 611 Latinos and 52 non-Latino white persons with symptoms of gastroesophageal Reflux ( GERD) (Los Angeles area, California). Barrett‘s esophagus was defined by the presence of columnar lined esophagus with intestinal metaplasia within biopsies obtained from endoscopically visible columnar lined esophagus.

The single center retrospective study found non-dysplastic Barrett‘s esophagus in 10% and 12% of GERD patients in the Latino and non-Latino group, respectively (p=0.64). One patient in the Latino group was found to have high grade Dysplasia.
The diagnosis of Barrett‘s esophagus positively correlated with male gender, age (> 55 years), diabetes and the use of ASA/NSAID in both Latino- and in the non-Latino group.

Taken together, Barrett‘s esophagus is present at a comparable frequency in Latinos and non-Latinos white individuals in Southern California. The observation, that Barrett‘s esophagus is positively linked to diabetes, indicates the role of life style, eating behavior and metabolic syndrome in the development of the disease.

iGERD comment:
The authors are to be congratulated for this excellent and important work. The paper is of actuality, novelty and major clinical relevance.
The only draw back of the study is, that the authors did not assess Barrett‘s esophagus at a normal esophagogastric junction, i.e. only patients with endoscopically visible columnar lined esophagus were included. Thus the study underestimates the frequency ob Barrett‘s esophagus. Recent studies found Barrett‘s esophagus in 15%-30% of the cases at a normal junction.
The important news of the paper: we have to balance the life style and the eating behavior. Otherwise the metabolic bomb will explode and the frequency of Reflux associated cancer of the esophagus will continue to rise.
In addition, metabolic syndrome patients should undergo screening Endoscopy of the esophagus for the exclusion of Barrett‘s esophagus. If Barrett‘s esophagus is assessed, we recommend the elimination by radiofrequency ablation (RFA, HALO®, BarrX Medical, Covidien).

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Histopathology of Barrett's esophagus: note the presence of goblet cells within columnar lined esophagus, this is the hallmark of Barrett's esophagus without Dysplasia (H&E stain, courtesy of Dr. Ildiko Mesteri and Prof. Fritz Wrba, Vienna).

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