Obesity drives malignant progression of Barrett’s esophagus

The risk of malignant progression in individuals with Barrett’s esophagus appears to be heightened among those with obesity, with the risk increase commensurate with BMI, according to the results of a meta-analysis.

Researchers searched multiple online databases for studies, in which the effect of BMI on the progression of nondysplastic Barrett’s esophagus or low-grade dysplasia to high-grade dysplasia or esophageal adenocarcinoma was evaluated.

A two-stage dose response meta-analysis was conducted to evaluate the dose-response association between BMI and malignant progression. A modified Newcastle-Ottawa scale was used to assess study quality.

The meta-analysis included 20 studies, with a total population of 38,565 patients (74.4 percent male). Of the patients, 1,684 received a diagnosis of high-grade dysplasia/cancer. Nineteen studies were deemed to have moderate-to-high quality.

Pooled data from eight cohort studies showed that of the 6,647 male patients with baseline nondysplastic Barrett’s esophagus/low-grade dysplasia, 555 progressed to high-grade dysplasia/esophageal adenocarcinoma (pooled annual rate of progression, 0.02 percent, 95 percent CI, 0.01–0.03). In female patients, progression occurred in 110 out of 1,992 (pooled annual rate of progression, 0.01 percent, 95 percent CI, 0.01–0.02). The difference in pooled annual rate of progression between male and female patients was not significant (p=0.15).

Of note, each 5-kg/m² increase in BMI correlated with a 6-percent increase in the risk of malignant progression (adjusted odds ratio, 1.06, 95 percent CI, 1.02–1.10; p<0.001; I²=0 percent).

The findings highlight the potential value of incorporating measures of obesity in future risk prediction models to improve risk stratification in patients with Barrett’s esophagus.