Ischemic heart disease, factor predisposing to Barrett’s adenocarcinoma: A case control study

Table 1 Clinical effects of aspirin in high risk population (clinical trials) n (%)

Characteristics	Patients in the analysis	Patients excluded from the analysis	P
Patients with esophageal adenocarcinoma
n	83	120
Age [mean (SD)], yr	73 (SD = 11.3)	73 (SD = 11.5)	1.00
Male gender	73 (61)	58 (70)	0.19
Current smokers	44 (37)	33 (40)	0.66
Cig. Cons. (in PY) [mean (SD)]	22.5 (SD = 30.2)	22.1 (SD = 27.3)	0.92
Alcohol abusers	32 (27)	21 (25)	0.96
BMI ≥ 25	57 (48)	40 (47)	0.96
Presence of hiatus hernia	73 (61)	52 (63)	0.91
Ischemic heart disease	40 (33)	27 (33)	0.97
Use of aspirin	17 (14)	12 (14)	0.88
Low socioeconomic status	26 (22)	18 (22)	0.87
Dur of reflux [in Y-mean (SD)]	28.5 (SD = 10.1)	27.8 (SD = 12.2)	0.66
Freq of refl (d/wk) [mean (SD)]	5.4 (SD = 2.4)	5.4 (SD = 2.6)	1.00
Patients with Barrett’s esophagus
n	426	521
Age [mean (SD)], yr	68 (SD = 14)	68 (SD = 13)	1.00
Male gender	264 (62)	316 (61)	0.73
Current smokers	136 (32)	174 (33)	0.68
Cig. Cons. (in PY) [mean (SD)]	19.8 (SD = 28.4)	20.3 (SD = 29.4)	0.79
Alcohol abusers	108 (25)	130 (25)	0.95
BMI ≥ 25	232 (54)	283 (54)	0.98
Barrett’s length (in cm)	6.6 (SD = 3.9)	6.6 (SD = 3.7)	1.00
Presence of hiatus hernia	304 (71)	371 (71)	0.98
Ischemic heart disease	83 (19)	99 (19)	0.92
Use of aspirin	87 (20)	109 (21)	0.91
Low socioeconomic status	69 (16)	83 (16)	0.98
Dur of reflux [in Y-mean (SD)]	16.1 (SD = 9.9)	16.4 (SD = 10.2)	0.65
Freq of refl (d/wk) [mean (SD)]	5.1 (SD = 2.3)	5.1 (SD = 2.5)	1.00

Cig. Cons.: Cigarette consumption in total throughout life; PY: Pack-years; BMI: Body mass index; Dur of reflux: Duration of reflux; Freq of refl (d/wk): Frequency of reflux episodes in days/week.

Table 2 Comparison of the main demographic endoscopic and clinical characteristics between patients with Barrett’s esophagus and esophageal adenocarcinoma n (%)

Characteristics	Barrett’s esophagus (n = 426)	Esophageal adenocarcinoma (n = 120)	P
Age [mean (SD)], yr	68 (SD = 14)	73 (SD = 11)	0.0003
Male gender	264 (61)	73 (61)	0.82
Smokers	136 (32)	44 (37)	0.39
Cig. Cons. (in PY) [mean (SD)]	19.8 (SD = 28.4)	22.5 (SD = 30.2)	0.36
Alcohol abusers	108 (25)	32 (27)	0.86
Barrett’s length (in cm)	6.6 (SD = 3.9)	7.5 (SD = 4.2)	0.03
Presence of hiatus hernia	304 (71)1	73 (61)	0.04
BMI ≥ 25	232 (54)	57 (48)	0.21
Low socioeconomic status	69 (16)	26 (22)	0.21
Dur of reflux (in Y) [mean (SD)]	16.1 (SD = 9.9)	28.5 (SD = 10.1)	< 0.0001
Freq of reflux (d/wk) [mean (SD)]	5.1 (SD = 2.3)	5.4 (SD = 2.4)	0.21

¹Thirty/fifty (60%) of patients with short segment Barrett present a hiatus hernia, as well as 5/10 (50%) with AdE on short segment Barrett esophagus. Y: Years; Cig. Cons.: Cigarette consumption in total throughout life; PY: Pack-years; BMI: Body mass index; Dur of reflux: Duration of reflux; Freq of reflux (d/wk): Frequency of reflux episodes in days/week.

Table 3 Comparison of the main demographic endoscopic and clinical characteristics between patients with Barrett esophagus without reflux symptoms and those with gastroesophageal reflux n (%)

Characteristics	Asymptomatic patients n = 40	Patients with GERD n = 386	P
Age [mean (SD)], yr	68 (SD = 8)	68 (SD = 15)	0.50
Male gender	28 (70)	236 (61)	0.35
Smokers	17 (43)	119 (31)	0.18
Cig. Cons. (in PY) [mean (SD)]	22.7 (SD = 29.6)	17.4 (SD = 25.6)	0.12
Alcohol abusers	13 (33)	95 (25)	0.37
Barrett’s length (in cm)	7.4 (SD = 5.1)	6.6 (SD = 3.9)	0.12
Presence of hiatus hernia	26 (65)	278 (72)	0.45
BMI ≥ 25	18 (45)	214 (55)	0.27
Low socioeconomic status	7 (18)	62 (16)	0.99

GERD: Gastroesophageal reflux disease; Cig. Cons.: Cigarette consumption in total throughout life; PY: Pack-years; BMI: Body mass index.

Table 4 Main demographic and disease related characteristics and treatment received in patients with ischemic heart disease and Barrett esophagus or esophageal adenocarcinoma n (%)

Characteristic	BE n = 83	AdE n = 40	P
Age [mean (SD)], yr	75 (SD = 10)	78 (SD = 10)	0.12
Male gender	54 (65)	23 (58)	0.54
Active smokers	23 (28)	10 (25)	0.92
Alcohol abusers	18 (22)	8 (20)	0.98
Cig. Cons. (in PY) [mean (SD)]	43 (SD = 25)	33 (SD = 17)	0.02
Low socioeconomic status	21 (25)	12 (30)	0.74
Diabetes	16 (19)	1 (3)	0.02
Barrett’s length (in cm)	6.4 (SD = 3.6)	7.1 (SD = 4.4)	0.35
Presence of hiatal hernia	55 (66)	27 (68)	0.95
Hyperlipidemia under treatment	77 (93)	36 (90)	0.86
Hypertension	58 (70)	30 (75)	0.71
Dur ref (in years) [mean (SD)]	19 (SD = 10)	28 (SD = 10)	< 0.0001
Freq ref (d/wk): [mean (SD)]	5.3 (SD = 2.3)	6 (SD = 2)	0.1
BMI ≥ 25	45 (54)	19 (48)	0.61
Use of beta-blockers	79 (95)	37 (93)	0.85
Sphincter relaxing medication	62 (75)	19 (47)	0.005
Low dose aspirin	42 (51)	12 (30)	0.03
Low dose aspirin daily	39 (47)	8 (20)	0.004

Cig. Cons.: Cigarette consumption in total throughout life; PY: Pack years; BMI: Body mass index; Dur ref: Duration of reflux; Freq ref (d/wk): Frequency of reflux episodes; BE: Barrett esophagus; AdE: Esophageal adenocarcinoma.

Table 5 Logistic regression analysis, in the whole study population, for known risk factors for esophageal adenocarcinoma development, various conditions co-existing with non-steroidal anti-inflammatory drugs use and various subgroups of non-steroidal anti-inflammatory drugs use

Variable	Odds ratio	CI of odds ratio	P
Age (per decade)	1.315	1.220-1.514	<0.001
Male gender	0.946	0.622-1.437	0.75
BE length (per 5 cm)	1.289	1.043-1.547	0.045
Length of HH (per 5 cm)	0.924	0.847-1.007	0.06
Duration of reflux (in decades)	1.848	1.686-2.060	<0.001
IHD	2.086	1.339-3.257	0.001
Daily aspirin use	0.623	0.346-1.111	0.65
Use of statins	0.576	0.356-0.918	0.02
Low socioeconomic status	1.411	0.844-2.351	0.43

IHD: Ischaemic heart disease; BE: Barrett esophagus.