PROGRESSION OF REFLUX-INDUCED ESOPHAGITIS TO BARRETT'S ESOPHAGUS AND ESOPHAGEAL ADENOCARCINOMA IS INDEPENDENT OF CHRONIC GERD SYMPTOMS

BACKGROUND: Uncontrolled gastroesophageal reflux disease (GERD) may result in the development of erosive esophagitis (EE), Barrett’s esophagus (BE) and ultimately esophageal adenocarcinoma (EAC). Traditionally, GERD symptoms guided screening for BE and EAC, but recent findings suggest removing GERD as a prerequisite for screening in patients with other risk factors. There is limited data as to the outcomes of symptomatic versus asymptomatic GERD with EE. This study aims to compare the incidence of BE and EAC in patients with and without GERD symptoms across a large, diverse healthcare system. METHODS: We studied all adults (>18 years of age), undergoing Esophagogastroduodenoscopy (EGD) within the Northwestern Medicine healthcare system (232 gastroenterologists, 1 academic medical center, and 12 community hospitals) between January 2018 and December 2022 with documentation of EE on endoscopy. Asymptomatic GERD was defined as patients without GERD per the electronic health record problem list, documented ICD 9/10 codes for GERD or use of proton pump inhibitors at the time of EGD. EE severity was defined by the Los Angeles (LA) classification. Patients with a history of treatment for BE/EAC and esophagitis attributable to non-reflux causes (infectious, eosinophilic, radiation, etc.) were excluded. Multivariate regression was used to identify risk factors predictive of progression to BE/EAC. RESULTS: A total of 28,983 total EGDs had findings of “esophagitis” over the study period of which 12,085 EGDs from 8,002 unique patients (3,763 asymptomatic and 4,239 symptomatic) were included. The population was predominately white (77.6%), non-Hispanic (87.1%) female (49.8%) with a mean age of 56.3 ± 15.2 years (Table 1). Symptomatic patients had higher rates of LA Grade C (11.8% vs.10.8%) and LA Grade D (7.2% vs. 5.9%) EE at index EGD (p<0.001). A total of 31% (n= 2,457) patients had follow-up endoscopy of which 68 (6.1%) asymptomatic patients versus 120 (8.9%) symptomatic progressed to BE (p=0.011). Progression to BE or EAC was associated with male sex (OR 1.65 CI 1.21-2.35), white race (OR 1.62 CI 1.06-2.46), prior smoking history (OR 1.71 CI 1.25-2.33), hiatal hernia (OR 2.23 CI 1.65-3.00), and presence of GERD symptoms (OR 1.46 CI 1.07-1.98) (Table 2). There was no difference between symptom status for the development of EAC (0.2% versus 0.2%). CONCLUSIONS: The current study across a large, diverse healthcare system highlights a significant rate of progression to BE in asymptomatic patients. While GERD symptoms remain a risk factor for the development of BE, age, male sex, white race, and smoking history all were more predictive of progression. These findings support the recent AGA Clinical Practice Update highlighting the need to consider BE and EAC screening in high-risk patients without chronic reflux symptoms.