Clinical characteristics of young patients with early Barrett’s neoplasia

Abstract

BACKGROUND Esophageal adenocarcinoma (EAC) and high-grade dysplasia (HGD) may appear in young patients with Barrett’s esophagus (BE). However, characteristics of Barrett’s-related neoplasia in this younger population remain unknown. AIM To identify clinical characteristics that differ between young and old patients with early-stage Barrett’s-related neoplasia. METHODS We conducted a retrospective analysis of a prospectively maintained database comprised of consecutive patients with early-stage EAC (pT1) and HGD at a tertiary-referral center between 2001 and 2017. Baseline characteristics, drug and risk factor exposures, clinicopathological staging of EAC/HGD and treatment outcomes [complete eradication of neoplasia (CE-N), complete eradication of intestinal metaplasia (CE-IM), recurrence of neoplasia and recurrence of intestinal metaplasia] were retrieved. Multivariate analyses were performed to identify factors that differed significantly between older and younger (≤ 50 years) patients. RESULTS We identified 450 patients with T1 EAC and HGD (74% and 26%, respectively); 45 (10%) were ≤ 50 years. Compared to the older group, young patients were more likely to present with ongoing gastroesophageal reflux disease (GERD) symptoms (55% vs 38%, P = 0.04) and to be obese (body mass index > 30, 48% vs 32%, P = 0.04). Multivariate logistic regression analysis showed that young patients were significantly more likely to have ongoing GERD symptoms [odds ratio (OR) 2.00, 95% confidence interval (CI) 1.04-3.85, P = 0.04] and to be obese (OR 2.06, 95%CI 1.07-3.98, P = 0.03) whereas the young group was less likely to have a smoking history (OR 0.39, 95%CI 0.20-0.75, P < 0.01) compared to the old group. However, there were no significant differences regarding tumor histology, CE-N, CE-IM, recurrence of neoplasia and recurrence of intestinal metaplasia (mean follow-up, 44.3 mo). CONCLUSION While guidelines recommend BE screening in patients > 50 years of age, younger patients should be considered for screening endoscopy if they suffer from obesity and GERD symptoms.

First Reported Case of Femoral Facial Syndrome in an Adult: Esophageal Adenocarcinoma as a Progressive Gastrointestinal Manifestation

“…Chronic GERD results in Barrett’s esophagus (BE), a precursor to esophageal adenocarcinoma (EAC) in which metaplastic columnar epithelium replaces the stratified squamous epithelium normally present in the distal esophagus [ 15 ]. BE intestinal metaplasia is the only recognized precursor for the development of EAC [ 15 - 16 ]. Thus, patients with symptoms of GERD should be identified, as this is the most important risk factor for the development of BE, which can evolve to EAC [ 15 ].…”

“…Obesity, specifically central adiposity, is another key risk factor for the development of EAC due to its contribution to acid reflux and adipocytokines resulting in a proinflammatory state [ 15 ]. EAC has a poor prognosis with a 42% survival rate after one year [ 16 ] and a five-year survival rate below 20% [ 16 ]. Currently, endoscopy screening guidelines are recommended for patients greater than 50 years old [ 16 ].…”

“…EAC has a poor prognosis with a 42% survival rate after one year [ 16 ] and a five-year survival rate below 20% [ 16 ]. Currently, endoscopy screening guidelines are recommended for patients greater than 50 years old [ 16 ]. Young patients (less than 50 years old) diagnosed with EAC commonly had current GERD symptoms (55%) and were obese (48%) [ 16 ], both of which were present in our young 42-year-old patient.…”

“…Currently, endoscopy screening guidelines are recommended for patients greater than 50 years old [ 16 ]. Young patients (less than 50 years old) diagnosed with EAC commonly had current GERD symptoms (55%) and were obese (48%) [ 16 ], both of which were present in our young 42-year-old patient. It should also be noted that the patient had a hiatal hernia, which may have likely exacerbated the patient’s GERD.…”

Esophageal abnormalities and the risk for gastroesophageal cancers—a histopathology-register-based study in Sweden

“…For each individual, we only kept the most severe biopsy finding from the first biopsy as baseline histopathology diagnosis. We excluded biopsies without a morphology code, those taken before 1979 (since large-scale registration of data in the pathology departments began in 1979) or after 2014 (2 years before the end of follow-up), patients younger than 30 years at first biopsy (since they might differ regarding etiology and risk according to previous literature [ 24 – 26 ]), individuals with data inconsistencies (died or emigrated at or before baseline biopsy), and patients with gastroesophageal cancer, esophagectomy or gastrectomy concurrent with or before the first biopsy. We also excluded patients with high-grade dysplasia, cancer in situ and eosinophilic esophagitis (Supplementary table 1) at the first biopsy since it was not within the scope of this study to examine these patients.…”