Risk of progression of Barrett's esophagus in patients with cirrhosis

Table 1 Characteristics of Barrett’s esophagus in cirrhotic patients

	No dysplasia (n = 45)	LGD (n = 5)	HGD/cancer (n = 7)	P value
Male	35 (77.8)	3 (60.0)	7 (100.0)	0.24
Age at cirrhosis diagnosis (yr)	57.0 (50, 64)	61 (48, 61)	68 (58, 72)	0.067
Age at BE diagnosis (yr)	57 (52, 64)	57 (50, 62)	67 (61, 71)	0.055
NASH	17 (38.6)	1 (20.0)	2 (28.6)	0.69
Cardiac cirrhosis	9 (20.5)	2 (40.0)	1 (14.3)	0.52
Hypertension	23 (51.1)	2 (40.0)	2 (28.6)	0.63
Diabetes	14 (31.1)	2 (40.0)	2 (28.6)	0.88
Hyperlipidemia	16 (35.6)	2 (40.0)	2 (28.6)	0.99
Varices	13 (28.9)	2 (40.0)	1 (14.3)	0.66
BE Length (cm)	3.3 ± 3.3	5.0 ± 3.7	3.2 ± 4.6	0.58
Presence of hiatal hernia	3 (6.8)	4 (80.0)	2 (28.6)	< 0.0011
Hiatal hernia length	2.7 ± 0.58	4.3 ± 0.96	3.5 ± 0.71	0.11
MELD-Na	10.7 ± 4.5	13.5 ± 10.7	10.8 ± 2.7	0.59
Child-Pugh class A	39	5	6	0.68
Class B	5	0	0
Class C	0	0	1
Follow-up (mo)	34.9 (13.0, 63.7)	44.2 (6.4, 50.6)	13.8 (4.5, 41.0)	0.16

¹Statistically significant; Statistics presented as mean ± SD, Median (P25, P75) or N (column %). BE: Barrett’s esophagus; NASH: Nonalcoholic steatohepatitis; LGD: Low grade dysplasia; HGD: High grade dysplasia; MELD-Na: Model for End-stage Liver Disease-Sodium.

Table 2 Patient characteristics: Non-cirrhotic vs cirrhotics n (%)

	No Cirrhosis(n = 228)	Cirrhosis(n = 57)	P value
Male	180 (78.9)	45 (78.9)	0.99
Age at BE (yr)	59.1 ± 9.6	58.9 ± 9.6	0.51
Body mass Index (kg/m2)	30.3 ± 6.0	30.6 ± 7.1	0.10
Ethnicity			0.97
Caucasian	214	54
African-American	3	1
Other	7	0
BE Length (cm)	2.7 ± 3.1	3.5 ± 3.4	0.20
Presence of hiatal hernia	128 (56.1)	9 (16.1)	< 0.0011
Hiatal hernia length (cm)	3.2 ± 1.5	3.6 ± 1.01	0.31
Baseline biopsy			0.10
No dysplasia	155 (68.0)	45 (78.9)
Low grade Dysplasia	28 (12.3)	5 (8.8)
High grade Dysplasia	29 (12.7)	5 (8.8)
Esophageal adenocarcinoma	16 (7.0)	2 (3.5)
Number of endoscopies	3 (2, 6)	2 (2, 4)	0.0091
Follow-up endoscopy (mo)	36.3 (13.6, 77.3)	31.9 (12.5, 57.3)	0.15

¹Statistically significant; Statistics presented as mean ± SD, Median (P25, P75) or n (%).

Table 3 Incidence rates of dysplasia and esophageal adenocarcinoma in cases vs controls

	Non-cirrhotic controls	Cirrhotic cases	P value
	(95%CI)	(95%CI)
No dysplasia at baseline
Person-years	866.4	176.1	-
LGD incidence per 100-person year	2.8 (1.9, 4.1)	4.0 (1.9, 8.4)	0.40
HGD incidence per 100-person year	0.92 (0.46, 1.8)	0.57 (0.08, 4.0)	0.65
EAC incidence per 100-person year	0.46 (0.17, 1.2)	0.57 (0.08, 4.0)	0.85
HGD/EAC incidence per 100-person year	1.4 (0.79, 2.4)	1.1 (0.28, 4.6)	0.80
LGD at baseline
Person-years	86.9	14.6	-
HGD incidence per 100-person year	5.8 (2.4, 13.8)	6.9 (0.97, 48.8)	0.87
EAC incidence per 100-person year	2.3 (0.58, 9.2)	6.9 (0.97, 48.8)	0.37
HGD/Cancer incidence per 100-person year	8.1 (3.8, 16.9)	13.7 (3.4, 55.0)	0.51

LGD: Low grade dysplasia; HGD: High grade dysplasia; EAC: Esophageal Adenocarcinoma.

Table 4 Factors associated with progression of Barrett's esophagus to dysplasia in cirrhotic patients

Factor	HR (95%CI)	P value
Male	1.9 (0.31, 11.6)	0.49
Age at Cirrhosis diagnosis (yr)	1.03 (0.97, 1.09)	0.31
Age at BE diagnosis (yr)	1.04 (0.97, 1.1)	0.28
Body mass index (kg/m2)	0.89 (0.79, 1.02)	0.085
Child-Pugh Class	7.9 (2.0, 30.9)	0.0031
Hypertension	0.72 (0.21, 2.5)	0.61
Diabetes Mellitus	0.86 (0.22, 3.3)	0.83
Hyperlipidemia	0.60 (0.16, 2.3)	0.46
MELD-Na	1.08 (0.95, 1.2)	0.23
BE length (cm)	1.1 (0.89, 1.4)	0.32
Hiatal Hernia size (cm)	1.7 (0.28, 10.5)	0.56

¹Statistically significant. BE: Barrett’s esophagus; HR: Hazard ratio; MELD-Na: Model for End-stage Liver Disease-Sodium.