October 5, 2020

Restrospective study identifies SSRIs and statins as inversely related to progression in Barrett's

This study evaluated some known and suspected novel risk factors, including a history of colonic adenomas, caffeine usage, histology, and use of statins and SSRIs as predictors of progression in Barrett's.

Restrospective study identifies SSRIs and statins as inversely related to progression in Barrett's

Sci Rep. 2020 Mar 17;10(1):4899. doi: 10.1038/s41598-020-61874-7.

Risk Factors for Progression of Barrett's Esophagus to High Grade Dysplasia and Esophageal Adenocarcinoma

Swetha Kambhampati, Alan H Tieu, Brandon Luber, Hao Wang, Stephen J Meltzer
Affiliations

PMID: 32184470 PMCID: PMC7078316 DOI: 10.1038/s41598-020-61874-7

Abstract

Barrett's esophagus (BE) is the only known precursor to esophageal adenocarcinoma (EAC). Methods of identifying BE patients at high risk for progression to high-grade dysplasia (HGD) or EAC are needed to improve outcomes and identify who will benefit most from intensive surveillance or ablative therapy. Clinical predictors of BE progression to HGD or EAC are poorly understood, with multiple contradictory studies. We performed a retrospective study which included 460 patients at Johns Hopkins Hospital who underwent at least 2 upper endoscopies 6 months apart showing biopsy-documented BE between 1992 and 2013. Patients with EAC or HGD at the initial endoscopy were excluded. Demographic, clinicopathological, and endoscopic data were collected. Univariate and multivariate Cox proportional hazards analyses with time to progression to HGD and EAC were performed. Among 460 patients included in the study, 132 BE patients developed HGD and 62 developed EAC. Significant EAC risk factors included age, abdominal obesity, caffeine intake, and the presence of HGD. Risk factors for HGD or EAC included age, caffeine intake, and low-grade dysplasia while colonic adenomas trended towards significance. Notably, a history of statin or SSRI usage reduced the risk of EAC or HGD by 49% or 61%, respectively. Our study validated several known and identified several novel risk factors, including a history of colonic adenomas or caffeine usage. Low-grade dysplasia was a risk factor for progression but various endoscopic characteristics were not, suggesting that screening strategies should focus on histology instead. We identified SSRIs as a new potentially chemoprotective medication.