Erridge S, et al. - Researchers aimed at analyzing the Clinical Practice Research Datalink (CPRD) to determine factors that increase the propensity of obese patients on proton pump inhibitors (PPIs) to develop Barrett’s esophagus (BE) and esophageal carcinoma. Findings suggested no association of higher BMIs with increased risk of BE or esophageal carcinoma in obese patients on PPI therapy for reflux. Increased risk of developing BE and carcinoma was exhibited by males, older patients, and those with hiatus hernias. They identified failure of PPI monotherapy as predictive of future metaplasia and dysplasia.

Methods

• Researchers conducted a case-control population study including patients from the CPRD.
• They extracted clinicopathological factors for each patient alongside clinical endpoints of gastroesophageal reflux disease (GERD), BE, and esophageal carcinoma.
• Factors that increase the propensity to develop BE and esophageal carcinoma were determined using multivariate analysis.
• Statistical significance was p < 0.050.

Results

• Researchers identified 165,929 obese patients on PPI treatment up until July 2017.
• They noted median follow-up time of 119.0 months (range 11.3–1397.9 months).
• Patients with GERD showed following to be associated with increased BE risk: age ≥ 60 years (OR = 1.197; p=0.039), male (OR = 2.209; p < 0.001), H2 antagonists (OR = 1.377; p<0.001), D2 antagonists (OR = 1.241; p=0.008), and hiatus hernias (OR = 6.772; p=0.017).
• The following were noted to be correlated with increased risk of esophageal carcinoma: age (OR = 2.831; p=0.031), male sex (OR = 3.954; p =0.003), and hiatus hernias (OR = 12.170; p < 0.001).
• Increased risk of developing esophageal carcinoma in BE patients was noted in association with D2 antagonists only (OR = 2.588; p=0.002).