Patients with Barrett's esophagus have a much increased risk of esophageal adenocarcinoma but recent evidence suggests no increase in overall mortality.
Dr Masoud Solaymani-Dodaran and colleagues from England reexamined this surprising finding in a large, prospectively population-based cohort study.
Cohorts of 1677 patients having Barrett's esophagus, 6392 with esophagitis, 6328 with simple reflux were included.
A standard reference cohort of 13,416 participants representing the general population were selected from General Practice Research Database.
The last 3 cohorts were matched to the Barrett's cohort by general practice, age, and sex.
|The excess mortality rate in the Barrett's cohort was 45%|
|American Journal of Gastroenterology|
Mortality rates and hazard ratios with their 95% confidence intervals were calculated for deaths due to all causes.
The research team also calculated deaths due to all causes except esophageal cancer occurring beyond the first year of the follow-up.
A total of 1725 deaths were analyzed including 49 deaths in subjects having esophageal cancer.
Of 111 deaths in the Barrett's cohort, the team found that 12% were in subjects with esophageal cancer.
Compared with the reference cohort, hazard ratios for all causes of death were 1.4 for the Barrett's, 1.16 for the esophagitis, and 1.16 for the reflux cohorts.
The investigators noted that corresponding figures for deaths due to all causes except esophageal cancer were 1.2, 1.13, and 1.15.
The excess mortality rates in the Barrett's, esophagitis, and reflux cohorts, were 45%, 20%, and 13%, respectively.
The investigators observed that the excess mortality rates in the 3 cohorts could be attributed to esophageal cancer.
Dr Solaymani-Dodaran's team concluded, “People with Barrett's esophagus and gastroesophageal reflux disease have higher mortality rates than the general population.”
“An increase in esophageal cancer risk accounts for less than half the excess mortality in Barrett's.”