Extraesophageal malignancies among patients with barrett esophagus

GOALS: To evaluate the incidence of extraesophageal malignancies among patients with Barrett esophagus (BE). BACKGROUND: Gastroesophageal reflux disease has been reported to be associated with upper aerodigestive malignancies. BE is considered a consequence of long-standing gastroesophageal reflux disease; however, the association of BE with extraesophageal malignancies is controversial. STUDY: The database of the largest health service provider in Israel was queried for all patients diagnosed with BE between 2000 and 2010. Data regarding medical background and diagnosis of malignancy were recorded. Malignancy rates were compared with subjects without BE or malignancy and matched for age, sex, and smoking status (1:4 ratio). Patients in whom a malignancy was diagnosed within 1 year of BE diagnosis were excluded. RESULTS: A total of 3669 patients with BE and 14,676 controls were included. Several nonesophageal malignancies were significantly more prevalent among BE patients: colorectal cancer (relative risk 1.98, P<0.001) and prostate cancer (relative risk 1.99, P<0.001), but not cancer of the upper aerodigestive tract. Multivariate analysis revealed that Jewish origin and the presence of BE were associated with higher malignancy risk [hazard ratio (HR) 1.83, HR 1.41, respectively; P<0.001]; body mass index was inversely associated with malignancy risk (HR 0.98; P<0.005). CONCLUSIONS: BE seems to be associated with colorectal and prostate cancer. Further research is necessary to determine whether this is a causative relationship and, consequently, whether a change in the screening policy for colorectal cancer in patients with BE is warranted.