Krishnamoorthi R, et al. - Factors associated with progression of Barrett’s esophagus (BE) without dysplasia or BE with low-grade dysplasia (LGD) to high-grade dysplasia or esophageal adenocarcinoma were identified in this systematic review. In this meta-analysis, factors associated with risk of progression of BE were older age, male sex, smoking, longer BE segment, and LGD. Individuals with these features needed to undergo more intensive surveillance or endoscopic therapy. In patients with BE, smoking was a modifiable risk factor for cancer prevention.

Methods

• Through May 2016, a systematic search of databases was performed to identify cohort studies of patients with baseline BE without dysplasia or BE with LGD that reported predictors of progression.
• The physicians calculated pooled estimates (odds ratios) of associations of age, sex, smoking, alcohol use, obesity, baseline LGD, segment length, and medication use with progression.

Results

• A total of 20 studies were identified, reporting 1,231 events in 74,943 patients.
• Factors associated with BE progression were increasing age (12 studies; odds ratio [OR], 1.03; 95% CI, 1.01–1.05), male sex (11 studies; OR, 2.16; 95% CI, 1.84–2.53), ever smoking (current or past, 8 studies; OR, 1.47; 95% CI, 1.09–1.98), and increasing BE segment length (10 studies; OR, 1.25; 95% CI, 1.16–1.36), with a low degree of heterogeneity.
• In this study, LGD was correlated with a 4-fold increase in risk of BE progression (11 studies; OR, 4.25; 95% CI, 2.58-7.0).
• Lower risk of BE progression was observed in association with the use of proton pump inhibitors (4 studies; OR, 0.55; 95% CI, 0.32–0.96) or statins (3 studies; OR, 0.48; 95% CI, 0.31–0.73).
• Data reported no association of alcohol use and obesity with risk of progression.