Risk of Barrett’s Esophagus progression to neoplasia low in women

Women appear to have a significantly lower risk of progression from Barrett’s Esophagus (BE) to cancer and high-grade dysplasia (HGD), according to a multicentre study.

The researchers obtained data from a large cohort of patients with BE seen at six centres in the US and Europe, followed for a median 5.7 years. Data on demographics (age, sex, ethnicity), clinical history (tobacco use, body mass index [BMI], comorbidities), endoscopy results (procedure date, BE segment length), and histopathology findings were then collected.

Neoplasia was classified as low-grade dysplasia, HGD, or esophageal adenocarcinoma (EAC). The researchers compared the rates of disease progression between men and women using χ² analysis and the Student t test. They also used multivariable logistic regression to examine the relationship between sex and disease progression after adjusting for possible confounding variables.

Of the 2,145 patients who met the eligibility criteria, 324 (15 percent) were women. Thirty-four (1.6 percent) incident EACs were recorded, with an overall annual incidence of 0.3 percent (95 percent confidence interval [CI], 0.2–0.4).

Significant differences were observed between men and women in annual incidence rates of EAC (0.03 percent in men vs 0.05 percent in women; p=0.04) and in the combined endpoint of HGD or EAC (1.10 percent for men vs 0.1 percent for women; p<0.001).

Female sex was independently associated with reduced progression to HGD or EAC when rates of progression were adjusted for BMI, smoking history, race, use of aspirin, nonsteroidal anti-inflammatory drugs, proton-pump inhibitors, or statins, hypertriglyceridaemia, BE length, and histology findings at baseline (hazard ratio, 0.11, 95 percent CI, 0.03–0.45; p=0.002).

“The extremely low risk of EAC in women with BE (0.05 percent/year) indicates that surveillance endoscopy may not be necessary for this subgroup of patients with BE,” the researchers said.