Jim Kling

November 02, 2012

LAS VEGAS, Nevada — Type 2 diabetes mellitus is a risk factor for Barrett's esophagus, according to a new study. The association was independent of body mass index (BMI), smoking, and gastroesophageal reflux disease (GERD).

These findings were presented here at the American College of Gastroenterology 2012 Annual Scientific Meeting and Postgraduate Course.

"Esophageal adenocarcinoma is rapidly rising in incidence and continues to be a lethal tumor. The goal is to determine what increases the risk of the precursor (Barrett's esophagus). If we find the precursor early enough, we could put these patients under surveillance or treat the precursor and reduce the risk," said Prasad Iyer, MD, associate professor of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota, who presented the research.

There is some evidence to suggest that central obesity is a risk factor for Barrett's esophagus and esophageal adenocarcinoma, through mechanical or metabolic mechanisms, such as hyperinsulinemia.

Some have speculated that fat in the abdomen could be a reflux-independent mechanism leading to Barrett's esophagus. Fat in the abdomen is also associated with insulin resistance. "That led us to study the link between diabetes and Barrett's esophagus," Dr. Iyer explained.

Population-Based Case–Control Data

The researchers conducted a population-based case–control study using the General Practice Research Database, which collects data on more than 8 million subjects in primary care in the United Kingdom. They identified 14,245 patients with Barrett's esophagus and 70,361 control subjects without who were matched for age, sex, enrolment date, duration of follow-up, and practice region.

They used conditional univariate and multivariate analyses to determine whether there is an association between type 2 diabetes and Barrett's esophagus, taking into account confounders such as smoking, obesity (measured by BMI), alcohol consumption, and the presence of GERD.

Patients with Barrett's esophagus were more likely to have smoked and consumed alcohol, had a higher BMI, and had a higher prevalence of type 2 diabetes than control subjects. On multivariate analysis, the researchers found a 49% increased risk for Barrett's esophagus in patients with type 2 diabetes. The link was stronger in men (odds ratio [OR], 2.03; 95% confidence interval [CI], 1.01 to 4.04) than in women (OR, 1.37; 95% CI, 0.63 to 2.97).

Replication Required

"In patients who have diabetes, Barrett's esophagus might be more likely to develop. We need to replicate these results. I wouldn't go around screening every patient with diabetes, but if they have other risk factors, such as smoking, reflux, or fat around the belly, then perhaps they should be tested for Barrett's esophagus," Dr. Iyer explained.

"It is fascinating" that diabetes can be separated out as a risk factor, Walter Coyle, MD, head of gastroenterology at the Scripps Clinic in La Jolla, California, told Medscape Medical News.

Still, he is not convinced that diabetes is a strong risk factor. "I think it is important from the perspective of the fattening of America. That's the take-home message for the public. [But] other risk factors have been [noted], such as smoking, age, and obesity. I'd focus on those," Dr. Coyle added.

The study was funded by Takeda Pharmaceuticals. Dr. Coyle reports being a consultant for CSA Medical.

American College of Gastroenterology (ACG) 2012 Annual Scientific Meeting and Postgraduate Course: Abstract 49. Presented October 23, 2012.

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