Digestive Diseases and Sciences

, Volume 63, Issue 11, pp 3112–3119 | Cite as

Prior Diagnosis of Barrett’s Esophagus Is Infrequent, but Associated with Improved Esophageal Adenocarcinoma Survival

  • Theresa Nguyen Wenker
  • Mimi C. Tan
  • Yan Liu
  • Hashem B. El-Serag
  • Aaron P. ThriftEmail author
Original Article



Efforts to reduce mortality from esophageal adenocarcinoma (EA) have focused on screening and surveillance of Barrett’s esophagus (BE).


We sought to determine the frequency of prior diagnosis of BE in patients with EA and to evaluate the impact of a prior BE diagnosis on mortality in EA patients.


This was a retrospective cohort study of patients diagnosed with EA in the VA during 2002–2016. We compared the distributions of EA stage and receipt of treatment between EA patients with and without a prior BE diagnosis and used Cox proportional hazards models to compare mortality risk (all-cause and cancer specific) unadjusted and adjusted for stage and treatment to assess their impact on any survival differences.


Among 8564 EA patients, only 4.9% had a prior BE diagnosis. The proportion with prior BE diagnosis increased from 3.2% in EA patients diagnosed during 2005–2007 to 7.0% in those diagnosed during 2014–2016. EA patients with a prior BE diagnosis were more likely to have stage 1 disease and receive any treatment. A prior BE diagnosis was associated with lower all-cause mortality risk (hazard ratio [HR] unadjusted for stage, 0.69; 95% CI, 0.61–0.80), which was largely explained by the earlier stage of EA at the time of diagnosis (HR adjusted for stage, 0.87; 95% CI, 0.75–0.99). There was no evidence of lead time bias or length time bias.


Prior diagnosis of BE was associated with better survival, largely due to earlier EA stage at diagnosis.


Esophageal neoplasms Surveillance Incidence Mortality 



Barrett’s esophagus


Confidence interval


Esophageal adenocarcinoma


Gastroesophageal reflux disease


Hazard ratio


Odds ratio


Author’s contribution

APT involved in study concept and design. Statistical analysis and interpretation of data were carried out by TN, MCT, YL, HES and APT. APT involved in data acquisition and obtained funding. YL prepared data. Drafting of the manuscript was performed by TN and APT. Critical review of the manuscript for important intellectual content was done by TN, MCT, YL, HES and APT. The study was supervised by APT. All authors read and approved the final version for submission.


This work was supported in part by National Institutes of Health grant P30 DK056338 (Study Design and Clinical Research Core), which supports the Texas Medical Center Digestive Diseases Center. Hashem El-Serag is also supported by NIDDK K24-04-107. This research was supported in part with resources at the VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (#CIN 13-413), at the Michael E. DeBakey VA Medical Center, Houston, TX. The opinions expressed reflect those of the authors and not necessarily those of the Department of Veterans Affairs, the US government or Baylor College of Medicine.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

10620_2018_5241_MOESM1_ESM.docx (30 kb)
Supplementary material 1 (DOCX 29 kb)


  1. 1.
    Thrift AP, Whiteman DC. The incidence of esophageal adenocarcinoma continues to rise: analysis of period and birth cohort effects on recent trends. Ann Oncol. 2012;23:3155–3162.CrossRefGoogle Scholar
  2. 2.
    Hur C, Miller M, Kong CY, et al. Trends in esophageal adenocarcinoma incidence and mortality. Cancer. 2013;119:1149–1158.CrossRefGoogle Scholar
  3. 3.
    Vaughan TL, Fitzgerald RC. Precision prevention of oesophageal adenocarcinoma. Nat Rev Gastroenterol Hepatol. 2015;12:243–248.CrossRefGoogle Scholar
  4. 4.
    Thrift AP. The epidemic of oesophageal carcinoma: where are we now? Cancer Epidemiol. 2016;41:88–95.CrossRefGoogle Scholar
  5. 5.
    Spechler SJ, Sharma P, Souza RF, et al. American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology. 2011;140:e18–e52.CrossRefGoogle Scholar
  6. 6.
    Shaheen NJ, Falk GW, Iyer PG, et al. ACG clinical guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol. 2016;111:30–50.CrossRefGoogle Scholar
  7. 7.
    Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7–42.CrossRefGoogle Scholar
  8. 8.
    Whiteman DC, Appleyard M, Bahin FF, et al. Australian clinical practice guidelines for the diagnosis and management of Barrett’s esophagus and early esophageal adenocarcinoma. J Gastroenterol Hepatol. 2015;30:804–820.CrossRefGoogle Scholar
  9. 9.
    Dulai GS, Guha S, Kahn KL, et al. Preoperative prevalence of Barrett’s esophagus in esophageal adenocarcinoma: a systematic review. Gastroenterology. 2002;122:26–33.CrossRefGoogle Scholar
  10. 10.
    Cooper GS, Kou TD, Chak A. Receipt of previous diagnoses and endoscopy and outcome from esophageal adenocarcinoma: a population-based study with temporal trends. Am J Gastroenterol. 2009;104:1356–1362.CrossRefGoogle Scholar
  11. 11.
    Cook MB, Drahos J, Wood S, et al. Pathogenesis and progression of oesophageal adenocarcinoma varies by prior diagnosis of Barrett’s oesophagus. Br J Cancer. 2016;115:1383–1390.CrossRefGoogle Scholar
  12. 12.
    Tramontano AC, Sheehan DF, Yeh JM, et al. The impact of a prior diagnosis of Barrett’s esophagus on esophageal adenocarcinoma survival. Am J Gastroenterol. 2017;112:1256–1264.CrossRefGoogle Scholar
  13. 13.
    SEER. Surveillance, Epidemiology, and End Results (SEER) Program ( SEER*Stat Database: Incidence - SEER 9 Regs Research Data, Nov 2016 Sub (1973-2014) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total US, 1969–2015 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, released April 2017, based on the November 2016 submission.
  14. 14.
    Bhat SK, McManus DT, Coleman HG, et al. Oesophageal adenocarcinoma and prior diagnosis of Barrett’s oesophagus: a population-based study. Gut. 2015;64:20–25.CrossRefGoogle Scholar
  15. 15.
    Corley DA, Mehtani K, Quesenberry C, et al. Impact of endoscopic surveillance on mortality from Barrett’s esophagus-associated esophageal adenocarcinomas. Gastroenterology. 2013;145:312–319.CrossRefGoogle Scholar
  16. 16.
    El-Serag HB, Naik AD, Duan Z, et al. Surveillance endoscopy is associated with improved outcomes of oesophageal adenocarcinoma detected in patients with Barrett’s oesophagus. Gut. 2016;65:1252–1260.CrossRefGoogle Scholar
  17. 17.
    Zullig LL, Jackson GL, Dorn RA, et al. Cancer incidence among patients of the US Veterans Affairs Health Care System. Mil Med. 2012;177:693–701.CrossRefGoogle Scholar
  18. 18.
    Jackson GL, Melton LD, Abbott DH, et al. Quality of nonmetastatic colorectal cancer care in the Department of Veterans Affairs. J Clin Oncol. 2010;28:3176–3181.CrossRefGoogle Scholar
  19. 19.
    Sohn MW, Arnold N, Maynard C, et al. Accuracy and completeness of mortality data in the Department of Veterans Affairs. Popul Health Metr. 2006;4:2.CrossRefGoogle Scholar
  20. 20.
    Duffy SW, Nagtegaal ID, Wallis M, et al. Correcting for lead time and length bias in estimating the effect of screen detection on cancer survival. Am J Epidemiol. 2008;168:98–104.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Section of Gastroenterology and Hepatology, Department of MedicineBaylor College of MedicineHoustonUSA
  2. 2.Center for Innovations in Quality, Effectiveness and Safety (IQuESt)Michael E DeBakey Veterans Affairs Medical CenterHoustonUSA
  3. 3.Section of Epidemiology and Population Sciences, Department of MedicineBaylor College of MedicineHoustonUSA
  4. 4.Dan L Duncan Comprehensive Cancer CenterBaylor College of MedicineHoustonUSA

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