Barrett's metaplasia and colonic neoplasms: a significant association in a 203,534-patient study

Factors Associated with Colorectal Polyps in Middle-Aged and Elderly Populations

Colorectal polyps are the precursor lesions of most colorectal cancers. This study aimed to evaluate associations between bone mineral density (BMD), metabolic syndrome (MetS), and gastrointestinal diseases with colorectal polyps in middle-aged and elderly populations. A retrospective cross-sectional study was performed using data from the health examination database of a tertiary medical center in southern Taiwan in 2015. Subjects aged 50 years and older who had been assessed for metabolic factors and had undergone colonoscopy, upper gastrointestinal endoscopy, and dual energy X-ray absorptiometry scan (DEXA) were included. Factors associated with colorectal polyps were evaluated using univariate and multivariate logistic regression. In total, 1515 subjects were included, with mean age 60.1 years. Among them, 710 (46.9%) had colorectal polyps. Multivariate logistic regression analysis showed that high fasting glucose (OR = 1.08, p = 0.001), high triglycerides (OR = 1.02, p = 0.008), high total cholesterol (OR = 1.004, p = 0.009), reflux esophagitis (OR = 1.44, p = 0.002), duodenal polyps (OR = 1.75, p = 0.026), gastric ulcer (OR = 1.38, p = 0.024), duodenal ulcers (OR = 1.45, p = 0.028), osteopenia (OR = 1.48, p = 0.001), and MetS (OR = 1.46, p < 0.001) were independently associated with colorectal polyps. In conclusion, hyperglycemia, hypercholesterolemia, hypertriglyceridemia, MetS, duodenal polyps, gastric and duodenal ulcers, reflux esophagitis, and low BMD are independent risk factors associated with colorectal polyps in the middle-aged and elderly Taiwanese population.

Association between gastroesophageal reflux disease and colorectal cancer risk: a population-based cohort study

PURPOSE

Several studies have investigated the association between gastroesophageal reflux disease (GERD) and colorectal cancer (CRC) risk, but the presented scientific results are highly debatable. This study examined the longitudinal association between GERD and CRC in an Asian population.

METHODS

A retrospective cohort study was performed using the National Health Insurance Research Database of Taiwan. The study cohort comprised 45,828 individuals with newly diagnosed GERD (the GERD cohort) and 229,140 age, sex, and date of enrollment-matched patients without GERD (the comparison cohort) from 2000 to 2006. The primary outcome was the incidence of CRC. To estimate the effect of GERD on the risk of CRC, the Cox proportional hazards model was fitted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

There were 785 newly diagnosed CRC patients in the 45,828 patients with GERD. Relatively, there were 2375 incident CRC cases in 229,140 patients without GERD. The incidence rate of CRC for the GERD cohort (17.60 per 10,000 person-years) was significantly higher than the corresponding incidence rate for the comparison cohort (10.22 per 10,000 person-years). After adjustment for confounders, GERD was associated with a significantly increased risk of CRC (adjusted HR,1.76; 95% CI, 1.62-2.90). Of note, a significant association between GERD and CRC risk was evident in both genders.

CONCLUSIONS

In conclusion, this nationwide population-based cohort study supports the hypothesis that GERD was associated with a significantly increased risk of CRC. Our findings warrant still further investigation of the underlying mechanisms related to carcinogenic effect of GERD on colorectal carcinoma.

Family History of Colorectal or Esophageal Cancer in Barrett's Esophagus and Potentially Explanatory Genetic Variants

We aimed to estimate the effects of a family history of colorectal cancer (CRC) or esophageal cancer on the risk of Barrett's esophagus (BE) and identify variants in cancer genes that may explain the association.

Relationship between Barrett's esophagus and colonic diseases: a role for colonoscopy in Barrett's surveillance

BACKGROUND

Given that risk factors for Barrett's carcinogenesis are predictive, appropriate management and surveillance of Barrett's esophagus (BE) may be provided. The presence of colorectal neoplasms (CRNs) is a possible predictor of the development of BE and the progression to esophageal adenocarcinoma (EAC). We evaluated the relationship between BE or EAC and colonic diseases, including neoplasms and diverticulosis.

METHODS

Patients (N = 5606) who underwent both colonoscopy and esophagogastroduodenoscopy between January 2016 and December 2017 at three institutions were enrolled. The relationships between the presence of colonic diseases and BE or EAC and other clinical or endoscopic predictors of the presence of BE were investigated retrospectively.

RESULTS

The prevalence of BE ≥ 1 cm and ≥ 3 cm in length was 13.0% and 0.52%, respectively. BE was closely related with the presence of colorectal adenoma (48.4% vs. 37.2% in non-BE; P < 0.001), adenocarcinoma (16.6% vs. 8.4%, P < 0.001) and colonic diverticulosis (CD) (34.1% vs. 29.3%, P < 0.001). In patients with long-segment BE, CRNs (79.3%, P < 0.001) and CD (48.2%, P = 0.038) were more common. EAC patients also had a statistically significantly higher incidence of CRNs than non-BE patients (87.5% vs. 45.6%, P = 0.027). Diverticulosis at the distal colon correlated significantly with EAC and BE (50.0%, P = 0.010 and 15.4%, P = 0.024, vs. 12.0% in non-BE). Multivariate analysis showed that CRNs (t = 8.55, P < 0.001), reflux esophagitis (t = 5.26, P < 0.001) and hiatal hernia (t = 11.68, P < 0.001) were predictors of BE.

CONCLUSIONS

The presence of CRNs was strongly associated with BE and EAC. Therefore, colonoscopy may be useful for establishing a strategy for the surveillance of BE.

Correlation of Barrett's esophagus with colorectal polyps in Japanese patients: A retrospective chart review

BACKGROUND AND AIM

Barrett's esophagus and colorectal polyps have several overlapping risk factors. Whereas several reports in Western countries have indicated a close relationship between Barrett's esophagus and colorectal polyps, the relationship between these two diseases remains unclear in Japan. This study was performed to determine whether the prevalence of Barrett's esophagus is related to that of colorectal polyps in Japanese patients.

METHODS

The present retrospective chart review included 1582 Japanese patients who underwent both total colonoscopy and esophagogastroduodenoscopy from January 2010 to December 2016. The data on colorectal polyps and Barrett's esophagus were obtained from the endoscopic findings. The medical record of each patient was checked for age, sex, body mass index, smoking, alcohol drinking, use of acid suppression agents, and comorbidities including a history of diabetes, ischemic heart disease, gastroesophageal reflux disease, hiatal hernia, and Helicobacter pylori infection.

RESULTS

Colorectal polyps were detected in 789 of the 1582 patients (49.9%). Barrett's esophagus was detected in 233 patients (14.7%), and most cases of Barrett's esophagus (n = 229) were classified as short-segment Barrett's esophagus. Colorectal polyps were more frequent in patients with than without Barrett's esophagus (odds ratio, 1.79; 95% confidence interval, 1.31-2.46; P < 0.001). In addition to Barrett's esophagus, the data indicated that old age, male sex, obesity, smoking, alcohol drinking, diabetes mellitus, and ischemic heart disease were independent risk factors for colorectal polyps.

CONCLUSIONS

The present study revealed the correlation between the prevalence of Barrett's esophagus and colorectal polyps in Japanese patients.

Barrett’s esophagus with high grade dysplasia is associated with non-esophageal cancer

AIM

To study factors associated with esophageal and non-esophageal cancer morbidity among Barrett’s esophagus (BE) patients.

METHODS

A cohort study within a single tertiary center included 386 consecutive patients with biopsy proven BE, who were recruited between 2004-2014. Endoscopic and histologic data were prospectively recorded. Cancer morbidity was obtained from the national cancer registry. Main outcomes were BE related (defined as esophagus and cardia) and non-BE related cancers (all other cancers). Cancer incidence and all-cause mortality were compared between patients with high-grade dysplasia (HGD) and with low-grade or no dysplasia (non-HGD) using Kaplan-Meier curves and cox regression models.

RESULTS

Of the 386 patients, 12 had HGD, 7 had a BE related cancer. There were 75 (19.4%) patients with 86 cases of lifetime cancers, 76 of these cases were non-BE cancers. Seven (1.8%) and 18 (4.7%) patients had BE and non-BE incident cancers, respectively. Twelve (3.1%) patients had HGD as worst histologic result. Two (16.7%) and 16 (4.4%) incident non-BE cancers occurred in the HGD and non-HGD group, respectively. Ten-year any cancer and non-BE cancer free survival was 63% and 82% in the HGD group compared to 93% and 95% at the non-HGD group, respectively. Log-rank test for patients with more than one endoscopy, assuring longer follow up, showed a significant difference (P < 0.001 and P = 0.017 respectively). All-cause mortality was not significantly associated with BE HGD.

CONCLUSION

Patients with BE and HGD, may have a higher risk for all-cause cancer morbidity. The implications on cancer prevention recommendations should be further studied.

Helicobacter pylori infection and esophageal adenocarcinoma: a review and a personal view

Esophageal adenocarcinoma (EAC) is etiologically associated with gastroesophageal reflux disease (GERD). There is evidence to support the sequence GERD, Barrett's esophagus (BE), dysplasia, and finally EAC, with Helicobacter pylori (H. pylori) being implicated in each step to EAC. On the other side of this relation stands the hypothesis of the protective role of H. pylori against EAC. Based on this controversy, our aim was to review the literature, specifically original clinical studies and meta-analyses linking H. pylori infection with EAC, but also to provide our personal and others' relative views on this topic. From a total of 827 articles retrieved, 10 original clinical studies and 6 meta-analyses met the inclusion criteria. Original studies provided inconclusive data on an inverse or a neutral association between H. pylori infection and EAC, whereas meta-analyses of observational studies favor an inverse association. Despite these data, we consider that the positive association between H. pylori infection and GERD or BE, but not EAC, is seemingly a paradox. Likewise, the oncogenic effect of H. pylori infection on gastric and colon cancer, but not on EAC, also seems to be a paradox. In this regard, well-designed prospective cohort studies with a powered sample size are required, in which potential confounders should be taken into consideration since their design.

Increased Risk for Colon Polyps in Patients with Reflux Disease

BACKGROUND

Previous studies have found an increased risk for colonic neoplasm in patients with Barrett's esophagus. It is unknown whether such risk applies similarly to other types of gastroesophageal reflux disease (GERD).

AIMS

To test whether GERD represents a risk factor for the occurrence of colon polyps.

METHODS

The Miraca Life Sciences Database is a large national electronic repository of histopathologic records of patients distributed throughout the entire USA. A case-control study evaluated whether presence of (1) Barrett's metaplasia, (2) erosive esophagitis on endoscopy or histologic signs of reflux esophagitis, (3) clinical diagnosis of GERD, (4) any type of GERD affected the occurrence hyperplastic polyps (HP), sessile serrated adenomas/polyps (SSA/P), or tubular adenomas (TA) among 228,506 subjects undergoing bidirectional endoscopy. Multivariate logistic regression analyses were used to calculate odds ratios and their 95% confidence intervals for the risk of HP, TA or SSA/P associated with various types of GERD and adjusted for age, sex, and presence of H. pylori.

RESULTS

The analysis revealed positive associations between GERD and all types of colon polyps. These associations applied similarly to HP (1.47, 1.44-1.50), TA (1.30, 1.27-1.32), and SSA/P (1.52, 1.46-1.58). They also applied to different forms of GERD, showing a trend toward stronger associations, that is higher odds ratios, with Barrett's metaplasia or erosive esophagitis than clinical diagnosis of GERD.

CONCLUSION

All types of GERD represent a risk factor for the occurrence of different colon polyps, such as HP, TA, or SSA/P.

Clinicopathological features of Siewert type II adenocarcinoma: comparison of gastric cardia adenocarcinoma and Barrett's esophageal adenocarcinoma following endoscopic submucosal dissection

OBJECTIVES

Siewert type II esophagogastric junction adenocarcinoma encompasses both gastric cardia adenocarcinoma (GCA) and Barrett's esophageal adenocarcinoma (BEA) due to short-segment Barrett's esophagus. We compared these two types of Siewert type II esophagogastric junction adenocarcinoma in terms of background factors and clinical outcomes of endoscopic submucosal dissection (ESD).

METHODS

We enrolled 139 patients (142 lesions) who underwent ESD from 2006 to 2014 at our institution. Background factors evaluated were age, sex, body mass index, hypertension, hyperlipidemia, hyperuricemia, diabetes mellitus, smoking, drinking, double cancer, and endoscopic findings. Clinical outcomes evaluated were procedure time, en bloc resection rate, curative resection rate, and adverse events.

RESULTS

There were 87 GCA lesions (61.2%) and 55 BEA lesions. Features of BEA [55 lesions (38.8%)] included a younger age, small diameter, and a protruding type, along with a high frequency of esophageal hiatal hernia and less mucosal atrophy. There were no significant differences in lifestyle-related background factors between the GCA and BEA groups. Curative resection rate was greater for GCA (81%) than for BEA (66%) (P = 0.01). There were no serious adverse events in either group. Among the factors for noncurative resection, lymphovascular invasion and depth of invasion were greater for BEA (33.3 vs. 7 and 20.7 vs. 8.2%, respectively (P < 0.01). Of the noncured patients, 70% underwent additional surgery and none had postoperative lymph node metastasis.

CONCLUSIONS

Siewert type II adenocarcinoma encompasses two types of cancers with different etiologies: GCA and BEA. Although there are no significant differences in lifestyle-related background factors between GCA and BEA, BEA is a risk factor for noncurative resection via ESD.

Correlation between Barrett's esophagus and colorectal polyps

AIM: To explore the correlation between Barrett's esophagus and colorectal polyps.

METHODS: A total of 41 patients with Barrett's esophagus and 176 controls were enrolled in the study. The incidence, pathological type and location of colorectal polyps were compared.

RESULTS: The incidence of polyps in patients with Barrett's esophagus was 41.5%, which was significantly higher than that of the control group (25.6%) (P = 0.042). The incidence of adenomatous polyps in patients with Barrett's esophagus was also significantly higher than that of the control group (P = 0.008), although there was no significant difference in the incidence of hyperplastic polyps and inflammatory polyps. The location of colorectal polyps showed no significant difference between the two groups. Logistic multivariate regression analysis revealed that Barrett's esophagus was an independent risk factor for colorectal polyps (OR = 2.397, 95%CI: 1.146-5.013, P = 0.020).

CONCLUSION: Patients with Barrett's esophagus have a higher incidence of colorectal polyps. Therefore, the screening and surveillance of colorectal polyps should be enhanced in patients with Barrett's esophagus.

Esophageal Squamous Cell Carcinoma Patients Have an Increased Risk of Coexisting Colorectal Neoplasms

Background/Aims

Esophageal squamous cell carcinoma (ESCC) and colorectal neoplasms (CRNs) share risk factors. We aimed to investigate whether the CRN risk is increased in ESCC patients.

Methods

ESCC patients who underwent a colonoscopy within 1 year of diagnosis were retrospectively analyzed. Patients were matched 1:3 by age, gender, and body mass index to asymptomatic controls. CRN was defined as the histological confirmation of adenoma or adenocarcinoma. Advanced CRN was defined as any of the following: ≥3 adenomas, high-grade dysplasia, villous features, tumor ≥1 cm, or adenocarcinoma. The risk factors for both CRN and advanced CRN were evaluated by univariate and multivariate analyses.

Results

Sixty ESCC patients were compared with 180 controls. The ESCC group had significantly higher numbers of CRNs (odds ratio [OR], 2.311; 95% confidence interval [CI], 1.265 to 4.220; p=0.006) and advanced CRNs (OR, 2.317; 95% CI, 1.185 to 4.530; p=0.013). Significant risk factors for both CRN and advanced CRN by multivariate analysis included ESCC (OR, 2.157, 95% CI, 1.106 to 4.070, p=0.024; and OR, 2.157, 95% CI, 1.045 to 4.454, p=0.038, respectively) and older age (OR, 1.068, 95% CI, 1.032 to 1.106, p<0.001; and OR, 1.065, 95% CI, 1.024 to 1.109, p=0.002, respectively).

Conclusions

The rates of CRN and advanced CRN are significantly increased in ESCC. Colonos-copy should be considered at ESCC diagnosis.

Higher prevalence of colon polyps in patients with Barrett's esophagus: a case-control study

Background and aims: Barrett’s esophagus (BE) and colorectal neoplasms share similar risk factors. Previous studies have shown variable prevalence of colon polyps in patients with BE. Our aims were to determine the prevalence and incidence of colon polyps in patients with BE, compared to those without BE.

Methods: In this case-control study, the study group included patients, aged 50–75 years, with biopsy-proven BE, who underwent colonoscopy at Cleveland Clinic from January 2002 to December 2011. The control group consisted of age- and sex-matched patients who underwent colonoscopy and also an endoscopy with no evidence of BE during the same time period. Exclusion criteria for both groups were family- or personal previous history of colon cancer or polyps, prior colonic resection, inflammatory bowel disease and familial polyposis syndromes. Patient demographics, comorbidities, medication use and endoscopic and colonoscopic details were collected, including biopsy results.

Results: A total of 519 patients were included in the study; 173 patients with BE in the study group and 346 without BE in the control group. Mean age at index colonoscopy was 61 ± 8 years and 75% of patients were male. On index colonoscopy, patients with BE were more likely to have polyps than controls (45% vs 32%, respectively; P = 0.003). Patients underwent between one and five colonoscopies during the follow-up. On multivariate analysis—after adjusting for age, gender and diabetes—patients with BE were 80% more likely to have any type of polyp, and 50% more likely to have adenomas found during colonoscopy.

Conclusions: Patients with BE had higher prevalence and incidence of colon polyps. This has important clinical implications for screening and surveillance in BE patients.