Published online Jun 28, 2019. doi: 10.3748/wjg.v25.i24.3069
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
Older age is one of the most important risk factors for Barrett’s esophagus. Most guidelines set the cut-off at age 50. On the other hand, the diagnosis of Barrett’s neoplasia in younger patients is becoming more common in daily clinical practice.
The clinical characteristics of these younger esophageal adenocarcinoma (EAC) and high-grade dysplasia (HGD) patients are poorly known. If this younger cohort differs significantly with respect to specific clinical characteristics from the more typical age category of Barrett’s neoplasia, these features could help to improve screening recommendations.
To identify factors associated with the development of Barrett’s neoplasia occurring in younger patients.
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 was conducted. 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.
Four hundred fifty patients with T1 EAC and HGD were enrolled in this study. Forty-five patients (10%) were ≤ 50 years. Compared to the older group, young patients were more likely to have ongoing gastroesophageal reflux disease (GERD) symptoms and to be obese. The same pattern of differences was maintained with an even greater magnitude of effects on multivariate analysis. 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).
We identified that patients ≤ 50 years old with early-stage EAC or HGD had greater odds of having ongoing GERD symptoms and to be obese than older patients. Our results may serve to improve the selection of younger patients who would most benefit from screening endoscopy.
Further prospective studies are needed to clarify the risk factors specific to young patients with Barrett’s-related neoplasia.