title: Serum 25-Hydroxyvitamin D Levels and the Risk of Dysplasia and Esophageal Adenocarcinoma in Patients with Barrett's Esophagus.
abstract: BACKGROUND
  To date, there are no studies reporting an association between vitamin D and Barrett's esophagus (BE), the precursor for esophageal adenocarcinoma (EAC).
  
  
  OBJECTIVE
  Our aim was to study the association between serum 25-hydroxyvitamin D (25(OH)D) levels and prevalence and incidence of dysplasia/EAC in BE.
  
  
  METHODS
  Patients from our BE Registry cohort seen between 2000 and 2012 who had serum 25(OH)D levels measured were included. Age, gender, race, BE length, hiatal hernia size, and histological findings were recorded. Patients without high-grade dysplasia (HGD)/EAC at or within 1 year of index biopsy and who had follow-up endoscopies and 25(OH)D levels were studied for incidence of dysplasia/EAC.
  
  
  RESULTS
  Among 429 patients with BE, the mean 25(OH)D level was 72 ± 31.2 nmol/L. Hundred and one (23.6 %) patients had deficiency (<50 nmol/L), 149 (34.7 %) had insufficiency (50-74.9 nmol/L), and 179 (41.7 %) had normal levels of 25(OH)D. There was no association between serum 25(OH)D levels and dysplasia (p = 0.90). In the incidence cohort of 246 patients with median follow-up of 46 months, there were 34 cases of low-grade dysplasia, 12 of HGD, and 5 of EAC. Change in 25(OH)D levels did not impact progression to dysplasia/EAC (every 5 nmol/L increase from baseline, hazard ratio 0.98; p = 0.62).
  
  
  CONCLUSIONS
  Serum 25(OH)D levels were low in 58.3 % of our BE cohort. There was no association between 25(OH)D levels and prevalence or incidence of HGD/EAC in patients with BE. Further long-term studies are needed to study the association between vitamin D status and progression of dysplasia in BE.
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. thotap@ccf.org.
authors.forename: Prashanthi N
authors.initials: PN
authors.lastname: Thota
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. kistang@ccf.org.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Kistangari
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. drprabhdeep1983@yahoo.com.
authors.forename: Prabhdeep
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospitals, 11100 Euclid Avenue, Mailstop 5066, Cleveland, OH, 44106-5066, USA. lcc15@case.edu.
authors.forename: Linda
authors.initials: L
authors.lastname: Cummings
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. hajifak@ccf.org.
authors.forename: Kaveh
authors.initials: K
authors.lastname: Hajifathalian
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. lopezr@ccf.org.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Department of Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. sanakam@ccf.org.
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology*; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000453:epidemiology*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D018450:Disease Progression; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D015995:Prevalence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D015415:Biomarkers; D014807:Vitamin D; C104450:25-hydroxyvitamin D
keywords: 25-Hydroxyvitamin D levels; Barrett’s esophagus; Dysplasia; Esophageal cancer; Progression