Risk Factors for the Development of Barrett's Esophagus and Esophageal Adenocarcinoma: A Systematic Review and Meta‐Analysis

ABSTRACT Background Barrett's esophagus (BE) is the most widely established precursor to esophageal adenocarcinoma (EAC). Despite current screening guidelines, more than 90% of EAC patients lack a previous diagnosis of BE. We performed a systematic review and meta‐analysis to identify the most...

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Main Authors: Kais Antonios, Daniel Aintabi, Patricia McNally, Elliot Berinstein, Priyata Dutta, Nicholas Sampson, Sichao Wang, Claudia Villarreal Carrillo, Brahm Singh, Marjan Haider, Richard A. Shellenberger
Format: Article
Language:English
Published: Wiley 2025-03-01
Series:Cancer Reports
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Online Access:https://doi.org/10.1002/cnr2.70168
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Summary:ABSTRACT Background Barrett's esophagus (BE) is the most widely established precursor to esophageal adenocarcinoma (EAC). Despite current screening guidelines, more than 90% of EAC patients lack a previous diagnosis of BE. We performed a systematic review and meta‐analysis to identify the most important risk factors for the development of BE or EAC. Recent Findings PubMed.gov, Ovid Medline, Embase, and Cochrane Library were searched through March 15, 2024. Studies comparing characteristics of patients with endoscopically diagnosed BE or EAC to control groups satisfied our inclusion criteria. Dual extraction provided data for random‐effects meta‐analyses. Sufficient data were extracted from 54 included studies to perform our meta‐analyses. There were five risk factors with significant associations for the development of BE: symptoms of gastroesophageal reflux at least once weekly (OR, 3.56; 95% confidence interval [CI], 2.03–6.25; p = 0.004) tobacco smoking (OR, 1.41; 95% CI, 1.30–1.51; p < 0.001); alcohol use (OR, 1.37; 95% CI, 1.10–1.71; p = 0.008); male gender (OR, 1.36; 95% CI, 1.19–1.57; p < 0.001); and obesity (BMI > 30 kg/m2) (OR, 1.23; 95% CI, 1.09–1.39; p = 0.003). Tobacco smoking was significantly associated with the diagnosis of EAC (OR, 2.15; 95% CI, 1.85–2.43; p < 0.001). Conclusion Five risk factors showed significant associations with the development of BE and one with the development of EAC, with over a three‐fold increase in BE for patients with gastroesophageal reflux more than once weekly. These data could prove useful in developing diagnostic paradigms with higher emphasis on patients experiencing more frequent acid reflux.
ISSN:2573-8348