Introduction Barrett’s oesophagus (BO) is where any portion of the normal distal squamous epithelial lining has been replaced by metaplastic columnar epithelium and is a risk factor for oesophageal adenocarcinoma. The recent BSG guidelines for the endoscopic surveillance of BO have stratified the risk according to the length of the BO segment and the presence or absence of intestinal metaplasia (IM). We aimed to identify risk factors and ethnic differences for the presence of IM.
Methods We performed a retrospective database analysis in our unit which serves a large ethnically diverse southwest London population. Gastroscopy records between 2009 and 2012 were retrieved and patients with an endoscopic diagnosis of BO were identified. Multiple procedure reports for individual patients were removed from the analysis. Demographic information included age, sex and length of the BO segment. Patients from the Indian sub-continent were also identified, as previously described.1 The presence of IM was retrieved from the hospital pathology database and was the primary outcome measured. We performed a multivariate logistic regression analysis to determine the odds of having IM by ethnic origin and other demographics.
Results 463 patients with an endoscopic diagnosis of Barrett’s oesophagus were identified. Median age of diagnosis was 67.2 years (IQR: 56.7–76.6 years). Men were more likely to have an endoscopic diagnosis of BO than females (71.3% vs. 29.7%, p = 0.01). 9.7% of the cohort were from the Indian sub-continent.
There was an increased odds of IM amongst men although this was not statistically significant (OR 1.44, 95% CI: 0.94–2.21, p = 0.09). Lesion length greater than 3cm compared with less than 3cm was associated with a greater odds of IM (2.37, 95% CI: 1.61–3.51, p= <0.001). Patients from the Indian sub-continent were 70% less likely to have IM compared to other ethnicities (OR 0.32, 95% CI: 0.16–0.61, p = 0.001).
Conclusion This data supports the previous findings that the BO lesion length of greater than 3 cm is associated with the presence of IM. Furthermore, the odds of having IM are significantly reduced in patients from the Indian sub-continent. Ethnicity should thus be taken into account in the future risk stratification of BO patients and requires further study.
Kang et al. Diverticular disease of the colon: ethnic differences in frequency. Aliment. Pharmacol. Ther. 2004: 19: 765-769
Disclosure of Interest None Declared.
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