Case Control Study
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World J Gastrointest Pharmacol Ther. Aug 6, 2014; 5(3): 183-190
Published online Aug 6, 2014. doi: 10.4292/wjgpt.v5.i3.183
Ischemic heart disease, factor predisposing to Barrett’s adenocarcinoma: A case control study
Panagiotis Tsibouris, Mark T Hendrickse, Panagiota Mavrogianni, Peter ET Isaacs
Panagiotis Tsibouris, Panagiota Mavrogianni, Gastroenterology Department, NIMTS General Hospital, 11521 Athens, Greece
Mark T Hendrickse, Peter ET Isaacs, Gastroenterology Department, Blackpool Victoria Hospital, Lancashire FY3 8NR, United Kingdom
Author contributions: Tsibouris P and Isaacs PET design the research; Tsibouris P, Hendrickse MT and Isaacs PET performed the research; Tsibouris P analyzed the data; Tsibouris P and Mavrogianni P wrote the paper.
Correspondence to: Panagiotis Tsibouris, PhD, Consultant Gastroenterologist, Gastroenterology Department, NIMTS General Hospital, 10-12 Monis Petraki Street, 11521 Athens, Greece. tsibofam@yahoo.com
Telephone: +30-210-7288107 Fax: +30-210-7257823
Received: November 12, 2013
Revised: April 6, 2014
Accepted: May 8, 2014
Published online: August 6, 2014
Abstract

AIM: To define the significance of ischemic heart disease (IHD) (stable angina to infarction) co-existance in Barrett esophagus (BE) patients and patients with esophageal adenocarcinoma (AdE).

METHODS: All BE/AdE patients in Blackpool-Wyre-Fylde area and Trikala prefecture identified from medical records. Patient clinical details were obtained from hospital and General Practitioner records. Additional information was gathered from validated questionnaire.

RESULTS: Forty (33%) AdE and 83 (19%) BE patients had IHD (P = 0.002). Eighteen (15%) AdE and 34 (8%) BE patients had suffered a myocardial infarction (P = 0.03). Three (3%) AdE and 7 (2%) BE patients had severe heart failure (P = 0.82). Thirty-nine (47%) BE with IHD and 8 (20%) AdE patients with IHD consumed aspirin daily (P = 0.004). Seventh-seven (93%) BE patients with IHD and 36 (90%) AdE patients with IHD were on statins (P = 0.86). Logistic regression analysis: AdE was more frequent in the elderly, with long term reflux, long BE and concurrent IHD (odds ratio: 2.086, P = 0.001) not consuming statins. Eighteen (22%) BE patients with IHD [16 (84%) with myocardial infarction] vs 33 (10%) without IHD died from non-neoplastic causes within 24 mo from BE diagnosis (P = 0.005).

CONCLUSION: IHD is more prevalent in AdE than BE patients. Increased prevalence of AdE is related with the presence of myocardial infarction but not severe heart failure, possibly because patients with BE and severe IHD have low life expectancy.

Keywords: Barrett esophagus, Esophageal adenocarcinoma, Ischemic heart disease, Myocardial infarction, Non-steroidal anti-inflammatory drugs

Core tip: Esophageal adenocarcinoma is a major health problem. We performed a population based retrospective comparison, shown that ischemic heart disease is twice as common among patients with esophageal adenocarcinoma than among those with uncomplicated Barrett esophagus. Although myocardial infarction was more frequently acquired in patients with esophageal adenocarcinoma, grade III or IV class heart failure was not, because patients with Barrett esophagus and severe heart failure usually have a low life expectancy and rarely survive longer than 2 years. Patients with Barrett esophagus and ischemic heart disease receive aspirin or nitrates every day more frequently than patients with esophageal adenocarcinoma.