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

Rena Yadlapati*, Joseph Triggs, Farhan Quader, Swathi Eluri, Shweta Bhatia, Alexander Kaizer, John E. Pandolfino, Srinadh Komanduri, Prakash Gyawali, Nicholas J. Shaheen, Paul Menard-Katcher, Sachin Wani

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)3631-3638
Number of pages8
JournalDigestive diseases and sciences
Volume65
Issue number12
DOIs
StatePublished - Dec 2020

Keywords

  • Esophageal adenocarcinoma
  • Esophageal contractility
  • Esophageal manometry
  • Esophageal motility
  • High-grade dysplasia
  • Intestinal metaplasia
  • Low-grade dysplasia
  • Proton pump inhibitor

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

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