Diabetes Tied to Barrett's Esophagus

Type 2 diabetes patients had increased risk of Barretts esophagus

(RxWiki News) Obesity may boost the risk of many health problems, including Barrett's esophagus. While it is unclear how obesity increases this risk, it could be linked to processes also involved in diabetes.

Patients with type 2 diabetes may have a higher risk of Barrett's esophagus - a condition in which the tube that carries food from the throat to the stomach is damaged by stomach acid.

"Lose weight to lower risk of Barrett's esophagus and diabetes."

In Barrett's esophagus, the damage and changes in the cells of the esophagus can lead to cancer.

In their study, Prasad G. Iyer, MD, of the Mayo Clinic College of Medicine, and colleagues wanted to see if there was a link between type 2 diabetes and Barrett's esophagus.

"Interestingly, we found that…if you had diabetes there was a two-fold increase in your risk for Barrett's esophagus," said Dr. Iyer. That is, patients with type 2 diabetes had twice the risk of Barrett's esophagus compared to those without diabetes.

Diabetes patients had this increased risk regardless of whether they had other risk factors for Barrett's esophagus - including smoking, drinking accessive amounts of alcohol, obesity and gastroesophageal reflux disease (GERD).

The researchers also found the link between type 2 diabetes and Barrett's esophagus was stronger in men than in women.

According to Dr. Iyer, the different risk between men and women may be related to where men and women are likely to store fat. Men are more likely than women to carry extra weight around their belly - a more dangerous area for fat to be stored.

"If you lose weight, your risk of Barrett's esophagus and esophageal cancer may decrease," said Dr. Iyer.

He also suggested that overweight patients - especially those who carry extra weight around their belly - ask their doctors about their risk for Barrett's esophagus and whether they need endoscopic screening for the condition.

Endoscopy for Barrett's esophagus is a process in which a tube is inserted down your throat so doctors can better see the lining of your esophagus. 

"The notion that abdominal obesity alone should be a reason for endoscopic screening for Barrett's esophagus is without any foundation," said Steven Kussin, MD, FACP, author of Doctor, Your Patient Will See You Now, Gaining the Upper Hand in Your Medical Care and a gastroenterology expert who was not involved in the study.

"Screening for Barrett's and surveillance for those with Barrett's is increasingly felt to be either unnecessary, optional or performed far more frequently than needed and new professional guidelines have backed this up.

Barrett's is too uncommon, its relation to abdominal obesity too speculative, and the benefits of endoscopic screening too controversial to make this a recommendation that patients bring to their doctors at this time," said Dr. Kussin.

"An endoscopy - including hospital costs, anesthesia (if given) and biopsies (if taken) - can cost upwards of $1,200," he said.

"Men are known to have greater risk for Barrett's. There is no reason abdominal obesity would itself predispose men to it, nor do the authors postulate a possible reason," said he said.

According to Dr. Iyer, it is not clear if obesity increases the risk of Barrett's esophagus through mechanical processes or through metabolic processes like hyperinsulinemia - a condition in which there is too much insulin in the blood. Hyperinsulinemia is often seen in people with type 2 diabetes but can happen as the result of a number of conditions.

In other words, the researchers asked if the increased risk occurs because of the physical aspects of obesity or because of deeper disease processes.

"Central obesity could cause increased acid reflux but this alone is unlikely to be a cogent reason for the development of Barrett's cellular changes. Nor is excess insulin secretion in the obese an established metabolic link to Barrett's. And again, no underlying science about hyperinsulinemia and its association with the cellular changes in Barrett's are given any background in this study," said Dr. Kussin.

"Some have pointed to excess insulin secretion in the obese and its association with some cancers (particularly colon cancer) but causality has not been demonstrated. For now, it's an association, not an etiology," he said.

"Most people with Barrett's live their entire lives without knowing they have it. The vast majority never get cancer," Dr. Kussin continued.

"The risks for cancer have recently been shown to be greatly overestimated. Over a 10 year period, of those who are known to have Barrett's esophagus, only 3 percent go on to get cancer. Ninety-seven percent don't. Even this number is inflated as the vast majority of people with Barrett's esophagus are never identified," said Dr. Kussin.

Dr. Iyer pointed out one weakness of the study was that it was a retrospective study, or a study that looked backwards in time for Barrett's esophagus risk. He said there is a need for more prospective studies, or studies that watch for outcomes during the study period.

For their study, the researchers looked at a database of more than 8 million patients. They spotted 14,245 cases of Barrett's esophagus and 70,361 people without Barrett's esophagus.

The research was presented at the 77th Annual Scientific Meeting of the American College of Gastroenterology. As such, the study has yet to be reviewed by a body of peers. 

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Review Date: 
October 22, 2012