Family history of Barrett's oesophagus, OAC a strong risk factor for each disease

Individuals with a family history of Barrett's oesophagus or oesophageal adenocarcinoma (OAC) are at risk of developing the said diseases, according to the results of a systematic review and meta-analysis.

Researchers accessed multiple online databases for studies and identified 102 articles that evaluated the association between family history and the risk of Barrett's oesophagus and OAC. The meta-analysis included 14 studies, which involved 16,189 patients with either Barrett's oesophagus or OAC.

Of the studies, eight were cohort studies and all were performed in Western countries (ie, the US and Europe). All diagnoses of the included index patients were confirmed using medical records and pathology reports. In all studies, Barrett's oesophagus was defined as >1 cm segment of salmon-coloured mucosa in the oesophagus combined with the presence of intestinal metaplasia in biopsies. The most frequently used definition of family history was having at least one first-degree relative with Barrett's oesophagus or oesophageal cancer.

Pooled data from nine studies showed that familial clustering was observed in 8.84 percent (95 percent confidence interval [CI], 5.54–13.82) of patients in the Barrett's oesophagus group and in 4.37 percent (95 percent CI, 2.15–8.69) of patients in the OAC group.

Across four studies, when patients with Barrett's oesophagus had their first-degree relatives screened, the resulting diagnostic yield for the same disease was between 12 percent and 44 percent. However, the diagnostic yield for high-grade dysplasia and OAC was low (<2 percent).

Individuals with a positive family history were more likely to have Barrett's oesophagus (adjusted relative risk [RR], 3.26, 95 percent CI, 1.43–7.40; I², 46 percent; three studies) and OAC (adjusted RR, 2.19, 95 percent CI, 1.14–4.21; I², 48 percent; five studies) compared with those who had no family history of the corresponding diseases.

The findings suggest that a positive family history could be a clinically meaningful way to identify high-risk individuals who may benefit from early detection strategies.