Predicting regression of Barrett's esophagus: results from a retrospective cohort of 1342 patients.
BACKGROUND
Barrett's esophagus (BE) is the most predictive risk factor for development of esophageal adenocarcinoma (EAC), a malignancy with the fastest increasing incidence in the US. The aim of this study was to investigate differences in exposures, demographics, and comorbidities between regressing and non-regressing patients.


METHODS
We retrospectively collected and analyzed data from a cohort of BE patients participating in a single-center study comprised of all patients diagnosed with BE over a 10-year period. We collected information from the patient's electronic medical records regarding demographic data, endoscopic findings, histological findings, exposures, and history of antireflux surgery.


RESULTS
This study included 1,342 BE patients, 505 (37.6%) of which experienced regression. The regressed group was 52.3% male, while the non-regressing group was 68.3% male (p < 0.001). Mean age was 65.2 ± 12.8 and 62.0 ± 13.1 years for non-regressing and regressing patients, respectively (p < 0.001). No difference was seen in BMI between regressing and non-regressing groups (27.5 ± 5.7 vs. 27.7 ± 5.4, p = 0.52). No difference was seen between groups with respect to PPI use (93.5% non-regressing vs. 94.1% regressed patients, p = 0.70), but regressed patients were more likely to take vitamin D than non-regressing patients (34.1 vs. 42.1%, p = 0.003). Regressed patients had an average segment length of 1.48 cm (±1.58 cm), in contrast to those not regressing (3.58 ± 3.09 cm (p < 0.001)). Interestingly, one patient in the regression group progressed to dysplasia, while 101 of the non-regressing patients progressed to dysplasia/EAC, a result found to be independent of segment length on multivariate analysis (p < 0.001).


CONCLUSIONS
Currently, several studies have shown risk factors that can predict progression of non-dysplastic BE, but few investigate predictors for regression. Our study reports several factors that can be used to predict patients who will regress from BE and those who likely will not, tools that will be useful in tailoring therapeutic and surveillance strategies.
NorthShore University Health Systems, NorthShore Center for Simulation and Innovation, Suite B665, 2650 Ridge Ave., Evanston, IL, 60201, USA, craigb@uchicago.edu.
Craig S
CS
Brown
Brittany
B
Lapin
Chi
C
Wang
Jay L
JL
Goldstein
John G
JG
Linn
Woody
W
Denham
Stephen P
SP
Haggerty
Mark S
MS
Talamonti
John A
JA
Howington
Joann
J
Carbray
Michael B
MB
Ujiki
D000230:Adenocarcinoma / Q000473:pathology; D000367:Age Factors; D000368:Aged; D001471:Barrett Esophagus / Q000473:pathology*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D015331:Cohort Studies; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009365:Neoplasm Regression, Spontaneous; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014807:Vitamin D / Q000008:administration & dosage
D050071:Bone Density Conservation Agents; D014807:Vitamin D