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

Abstract

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.

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

“…A few studies have shown that Barrett's esophagus was not associated with the risk of colorectal polyps, but the number of subjects in those studies was limited . Some studies have indicated that the relative risk of Barrett's esophagus in the presence of any type of colorectal polyps was 1.8 and that the risk of adenomas was 1.5 . These relative risks are similar to those in the present study.…”

“…This proportion is equivalent to that in previous reports in Japan, in which the frequency of SSBE ranged from 10.3% to 43.0% (average, 17.9%) and that of LSBE ranged from 0.2% to 1.4% (average, 0.4%) . Most patients with Barrett's esophagus in Western countries have LSBE, and many studies of the relationship between Barrett's esophagus and colorectal polyps in the West have focused on LSBE . As indicated in the present study, the several risk factors of SSBE in Japan including obesity H. pylori infection and reflux esophagitis were similar to the risk factors of LSBE in Western countries.…”

“…There are various potential explanations for the association between Barrett's esophagus and colorectal polyps. Although the mechanisms remain unclear, patients with Barrett's esophagus are more likely to have some of the same risk factors as patients with colorectal polyps, including older age, male sex, alcohol drinking, smoking, and obesity . In the present study, the patients with colorectal polyps had risk factors including older age, male sex, obesity, smoking, and alcohol drinking, which overlap the risk factors for Barrett's esophagus.…”

“…first described the association between Barrett's esophagus and colorectal polyps. Since that description, several authors have proposed an association between Barrett's esophagus and colorectal polyps in Western countries . A few studies have shown that Barrett's esophagus was not associated with the risk of colorectal polyps, but the number of subjects in those studies was limited .…”

“…[16][17][18][19][20][21] Although the definition of Barrett's esophagus differs between Japan and Western countries, [21][22][23][24] the prevalence of Barrett's esophagus is higher in Western countries than in Japan. 17,25,26 Several reports in Western countries have indicated a close relationship between Barrett's esophagus and colorectal neoplasia, 14,[27][28][29][30][31][32][33] but the relationship between these two diseases remains unclear in Japan. The present study was performed to determine whether the prevalence of Barrett's esophagus is related to that of colorectal polyps in Japanese patients.…”