Colorectal neoplasia in veterans is associated with Barrett's esophagus but not with proton-pump inhibitor or aspirin/NSAID use.
BACKGROUND
It has been suggested that Barrett's esophagus (BE) is associated with an increased risk of developing colorectal neoplasia, but this has not been reported consistently.


OBJECTIVE
To study whether BE is associated with an increased risk of colorectal neoplasia, and if it is, whether it is dependent on use of proton-pump inhibitors (PPIs) or aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).


METHODS
Case-control study.


METHODS
Endoscopic database of the Palo Alto Veterans Affairs Health Care System.


METHODS
268 veterans with BE were matched with 268 controls without BE.


METHODS
Controls had undergone upper GI endoscopy within 14 days of the corresponding case. Colonoscopy was performed within 6 months in cases and controls.


METHODS
Development of colorectal neoplasia.


RESULTS
Colorectal neoplasia was present in 162 of 268 (60%) BE patients and in 105 of 268 (40%) controls (p < 0.001). The presence of BE (odds ratio [OR] 2.02: 95% CI [1.35, 3.04]), but also increasing age (OR 1.24 per decade: 95% CI [1.04, 1.48]) and alcohol use (OR 1.70: 95% CI [1.16, 2.50]) were associated with an increased risk of colorectal neoplasia in multivariable logistic regression analysis, whereas PPIs (OR 0.99: 95% CI [0.66, 1.48]) and aspirin/NSAIDs (OR 0.90: 95% CI [0.61, 1.33]) had no meaningful effect.


CONCLUSIONS
This was a retrospective study in mostly male veterans.


CONCLUSIONS
Veterans with BE are at an increased risk of developing colorectal neoplasia. This association is independent from the use of PPIs or aspirin/NSAIDs.
Departments of Gastroenterology and Hepatology and Public Health, Erasmus MC-University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands.
Peter D
PD
Siersema
Stanley
S
Yu
Peyman
P
Sahbaie
Ewout W
EW
Steyerberg
Peter W
PW
Simpson
Ernst J
EJ
Kuipers
George
G
Triadafilopoulos
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D001471:Barrett Esophagus / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D001706:Biopsy; D002140:California / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D054328:Proton Pump Inhibitors; D012189:Retrospective Studies; D012307:Risk Factors; D012812:Sigmoidoscopy; D014728:Veterans
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D001241:Aspirin