Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 28, 2019; 25(24): 3069-3078
Published online Jun 28, 2019. doi: 10.3748/wjg.v25.i24.3069
Clinical characteristics of young patients with early Barrett’s neoplasia
Yugo Iwaya, Yuto Shimamura, Kenichi Goda, Enrique Rodríguez de Santiago, John Gerard Coneys, Jeffrey D Mosko, Gabor Kandel, Paul Kortan, Gary May, Norman Marcon, Christopher Teshima
Yugo Iwaya, Yuto Shimamura, John Gerard Coneys, Jeffrey D Mosko, Gabor Kandel, Paul Kortan, Gary May, Norman Marcon, Christopher Teshima, Advanced Therapeutic Endoscopy Centre, St Michael’s Hospital, University of Toronto, Toronto M5B 1W8, Ontario, Canada
Kenichi Goda, Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan
Enrique Rodríguez de Santiago, Department of Gastroenterology, Ramón y Cajal university hospital, Madrid 28034, Spain
Author contributions: All authors helped to perform the research; Iwaya Y, Shimamura Y, Goda K, Coneys JG, Mosko JD, Kandel G, Kortan P, May G, Marcon N and Teshima C contribution to writing the manuscript; Shimamura Y, Goda K, Rodríguez de Santiago E and Teshima C contribution to drafting conception and design; Iwaya Y contribution to performing procedures; Iwaya Y and Rodríguez de Santiago E contribution to data analysis; Coneys JG, Mosko JD, Kandel G, Kortan P, May G and Marcon N contribution to performing experiments; all the authors have approved the final draft submitted.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of St. Michael’s Hospital, University of Toronto.
Informed consent statement: Written informed consents for the upper GI endoscopy and their inclusion in our database were obtained from all participants.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yugo Iwaya, MD, PhD, Doctor, Advanced Therapeutic Endoscopy Centre, St Michael’s Hospital, University of Toronto, 30 Bond Street, Toronto M5B 1W8, Ontario, Canada. yiwaya@shinshu-u.ac.jp
Telephone: +1-416-864-3092
Received: April 1, 2019
Peer-review started: April 1, 2019
First decision: April 30, 2019
Revised: May 7, 2019
Accepted: May 18, 2019
Article in press: May 18, 2019
Published online: June 28, 2019
Processing time: 90 Days and 3.7 Hours
Abstract
BACKGROUND

Esophageal adenocarcinoma (EAC) and high-grade dysplasia (HGD) may appear in young patients with Barrett’s esophagus (BE). However, characteristics of Barrett’s-related neoplasia in this younger population remain unknown.

AIM

To identify clinical characteristics that differ between young and old patients with early-stage Barrett’s-related neoplasia.

METHODS

We conducted a retrospective analysis of a prospectively maintained database comprised of consecutive patients with early-stage EAC (pT1) and HGD at a tertiary-referral center between 2001 and 2017. Baseline characteristics, drug and risk factor exposures, clinicopathological staging of EAC/HGD and treatment outcomes [complete eradication of neoplasia (CE-N), complete eradication of intestinal metaplasia (CE-IM), recurrence of neoplasia and recurrence of intestinal metaplasia] were retrieved. Multivariate analyses were performed to identify factors that differed significantly between older and younger (≤ 50 years) patients.

RESULTS

We identified 450 patients with T1 EAC and HGD (74% and 26%, respectively); 45 (10%) were ≤ 50 years. Compared to the older group, young patients were more likely to present with ongoing gastroesophageal reflux disease (GERD) symptoms (55% vs 38%, P = 0.04) and to be obese (body mass index > 30, 48% vs 32%, P = 0.04). Multivariate logistic regression analysis showed that young patients were significantly more likely to have ongoing GERD symptoms [odds ratio (OR) 2.00, 95% confidence interval (CI) 1.04-3.85, P = 0.04] and to be obese (OR 2.06, 95%CI 1.07-3.98, P = 0.03) whereas the young group was less likely to have a smoking history (OR 0.39, 95%CI 0.20-0.75, P < 0.01) compared to the old group. However, there were no significant differences regarding tumor histology, CE-N, CE-IM, recurrence of neoplasia and recurrence of intestinal metaplasia (mean follow-up, 44.3 mo).

CONCLUSION

While guidelines recommend BE screening in patients > 50 years of age, younger patients should be considered for screening endoscopy if they suffer from obesity and GERD symptoms.

Keywords: Barrett’s Esophagus; Gastroesophageal reflux disease; Obesity; Esophageal adenocarcinoma; High-grade dysplasia; Guideline; Young patient

Core tip: Esophageal adenocarcinoma (EAC) and high-grade dysplasia (HGD) may appear in young patients with Barrett’s esophagus (BE). To identify clinical characteristics of young patients with Barrett’s neoplasia, we conducted a retrospective analysis. 450 patients with T1 EAC and HGD were identified; 45 (10%) were young patients at age ≤ 50 years. Compared to the older group, young patients were more likely to present with ongoing gastroesophageal reflux disease (GERD) symptoms and to be obese on multivariate analysis. While guidelines recommend BE screening in patients > 50 years of age, younger patients should be considered for screening endoscopy if they suffer from obesity and GERD symptoms.