Zhou Margaret J, Hsing Ann W, Clarke John O
Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CAUSA.
Department of Medicine and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.
Dis Esophagus. 2025 Jan 7;38(1). doi: 10.1093/dote/doae120.
Data on Barrett's esophagus (BE) and esophageal cancer (EC) outcomes in patients with eosinophilic esophagitis (EoE) are limited. We aimed to determine the risk of prevalent BE (<1 year after endoscopy), incident BE (≥1 year after endoscopy), and incident EC in patients with versus without EoE, and to identify predictors of BE/EC in EoE patients. We identified adult patients in the Merative MarketScan Database who underwent first-time upper endoscopy between 2008 and 2020. Chi-square analysis compared proportions of patients with versus without EoE who had BE or EC. Multivariate Cox regression determined associations between demographics/comorbidities and incident BE/EC in the EoE cohort, adjusting for established BE risk factors. Among 2,947,003 patients who underwent upper endoscopy, 20,588 patients (0.70%) had EoE (mean age 40.6 years, 63.8% male, gastroesophageal reflux disease in 44.9%). Prevalent BE, incident BE, and incident EC was found in 1.03%, 0.57%, and 0.06% of patients with EoE versus 1.06%, 0.54%, and 0.05% of patients without EoE, respectively (P = 0.13, 0.21, and 0.36, respectively). Among individuals with EoE, older age, male sex, presence of a hiatal hernia, gastroesophageal reflux disease, and location in North Central or Southern USA were independently associated with incident BE. Older age and prevalent BE were independently associated with incident EC. BE/EC risk in EoE is comparable to that of the baseline population undergoing upper endoscopy. Our findings support current understanding that EoE is not associated with an increased risk of BE/EC and reinforce that conventional BE screening strategies can be applied in patients with EoE.
嗜酸性食管炎（EoE）患者的巴雷特食管（BE）和食管癌（EC）转归数据有限。我们旨在确定EoE患者与非EoE患者中现患BE（内镜检查后<1年）、新发BE（内镜检查后≥1年）和新发EC的风险，并确定EoE患者中BE/EC的预测因素。我们在Merative MarketScan数据库中识别出2008年至2020年间接受首次上消化道内镜检查的成年患者。卡方分析比较了有或无EoE且患有BE或EC的患者比例。多变量Cox回归确定了EoE队列中人口统计学/合并症与新发BE/EC之间的关联，并对已确定的BE危险因素进行了校正。在2947003例接受上消化道内镜检查的患者中，20588例患者（0.70%）患有EoE（平均年龄40.6岁，男性占63.8%，44.9%患有胃食管反流病）。EoE患者中现患BE、新发BE和新发EC的比例分别为1.03%、0.57%和0.06%，而非EoE患者分别为1.06%、0.54%和0.05%（P分别为0.13、0.21和0.36）。在患有EoE的个体中，年龄较大、男性、存在食管裂孔疝、胃食管反流病以及位于美国中北部或南部与新发BE独立相关。年龄较大和现患BE与新发EC独立相关。EoE患者的BE/EC风险与接受上消化道内镜检查的基线人群相当。我们的研究结果支持了目前的认识，即EoE与BE/EC风险增加无关，并强化了传统的BE筛查策略可应用于EoE患者的观点。
