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Reduced Esophageal Contractility Is Associated with Dysplasia Progression in Barrett’s Esophagus: A Multicenter Cohort Study

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Abstract

Background

The incidence of Barrett’s esophagus (BE) and esophageal adenocarcinoma (EAC) continues to rise, and risk stratification of patients with BE is needed. Impaired esophageal motility is associated with gastroesophageal reflux disease; however, whether esophageal dysmotility is a risk factor for dysplasia progression in BE is incompletely understood. This study aimed to characterize esophageal motility patterns in patients with BE and identify physiologic factors associated with dysplasia progression in BE.

Methods

This multicenter retrospective study assessed data from adult patients with histologically confirmed BE who underwent high-resolution esophageal manometry from 1/2014 to 1/2018 at four tertiary care centers. Longitudinal data were collected when available among patients with non-dysplastic BE (NDBE) and separated as: no dysplastic progression or positive dysplastic progression. Multivariable logistic regression assessed for independent predictors of dysplasia progression.

Results

Among 193 patients, histology at index endoscopy identified 152 (79%) NDBE, 23 (12%) low-grade dysplasia, 14 (7%) high-grade dysplasia, and 4 (2%) EAC. Ninety-eight (51%) had abnormal esophageal motor function on manometry. Longitudinal data were available for 84 of 152 patients with initial NDBE. Twelve (14%) exhibited dysplastic progression to low-grade (6) or high-grade (6) dysplasia. Mean esophageal distal contractile integral was lower for patients that progressed [455 mmHg s cm (SD 515)] compared with patients who did not progress [987 mmHg s cm (SD 953); aOR 1.21 (95% CI 1.01, 1.44)].

Conclusion

In this retrospective study of 193 BE patients, the majority exhibited abnormal esophageal motor function. Reduced esophageal contractility was independently associated with dysplastic progression in BE. Characterizing esophageal physiology in BE may help to risk stratify patients.

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Abbreviations

BE:

Barrett’s esophagus

EAC:

Esophageal adenocarcinoma

NDBE:

Non-dysplastic Barrett’s esophagus

LGD:

Low-grade dysplasia

HGD:

High-grade dysplasia

PPI:

Proton pump inhibitor

GERD:

Gastroesophageal reflux disease

BMI:

Body mass index

IRP:

Integrated relaxation pressure

DCI:

Distal contractile integral

EGJ-CI:

Esophagogastric junction contractile integral

PSPWi:

Post-reflux swallow peristaltic wave index

aOR:

Adjusted odds ratio

CI:

Confidence interval

SD:

Standard deviation

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Authors and Affiliations

  1. Division of Gastroenterology, University of California, San Diego School of Medicine, ACTRI Building 1W517, 9500 Gilman Drive MC 0956, La Jolla, CA, 92093, USA

    Rena Yadlapati

  2. Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Joseph Triggs, John E. Pandolfino & Srinadh Komanduri

  3. Division of Gastroenterology and Hepatology, Washington University School of Medicine, St. Louis, MO, USA

    Farhan Quader & Prakash Gyawali

  4. Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Swathi Eluri, Shweta Bhatia & Nicholas J. Shaheen

  5. Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA

    Alexander Kaizer

  6. Division of Gastroenterology and Hepatology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA

    Paul Menard-Katcher & Sachin Wani

Authors
  1. Rena Yadlapati
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  2. Joseph Triggs
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  3. Farhan Quader
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  4. Swathi Eluri
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  5. Shweta Bhatia
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  6. Alexander Kaizer
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  7. John E. Pandolfino
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  8. Srinadh Komanduri
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  9. Prakash Gyawali
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  10. Nicholas J. Shaheen
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  11. Paul Menard-Katcher
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  12. Sachin Wani
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Contributions

RY, SW, JT, FQ, SE, SB, JP, SK, PG, PMK contributed to study concept and design; RY and SW involved in study oversight; RY, SW, ZV, JT, FQ, SE, SB, JP, SK, PG, NJS, PMK participated in acquisition of data; RY, SW, AK took part in analysis and interpretation of data; RY, SW, AK, JT, FQ, SE, SB, JP, SK, PG, PMK involved in drafting of manuscript; RY, SW, AK, JT, FQ, SE, SB, JP, SK, PG, NJS, PMK took part in critical revision of the manuscript for important intellectual content; RY, SW, AK, JT, FQ, SE, SB, JP, SK, PG, NJS, PMK participated in finalization of manuscript.

Corresponding author

Correspondence to Rena Yadlapati.

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Conflict of interest

JEP: Consultant for Crospon, Ironwood, Torax, Astra Zeneca, Takeda, Impleo, Medtronic, Sandhill.

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Yadlapati, R., Triggs, J., Quader, F. et al. Reduced Esophageal Contractility Is Associated with Dysplasia Progression in Barrett’s Esophagus: A Multicenter Cohort Study. Dig Dis Sci 65, 3631–3638 (2020). https://doi.org/10.1007/s10620-020-06098-5

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  • DOI: https://doi.org/10.1007/s10620-020-06098-5

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