Digestive Diseases and Sciences

, Volume 58, Issue 7, pp 2046–2051 | Cite as

Barrett’s Metaplasia and Colonic Neoplasms: A Significant Association in a 203,534-Patient Study

  • Amnon Sonnenberg
  • Robert M. Genta
Original Article


Background and Aim

The presence of an association between Barrett’s metaplasia and colonic neoplasia has remained controversial. The aim of the study was to test the presence of this association, using a large national database.


From a computerized database of surgical pathology reports, we selected 203,000 subjects who underwent colonoscopy and esophago-gastro-duodenoscopy with biopsy results available from both procedures. In a case–control study we compared the occurrence of Barrett’s metaplasia in patients with and without various types of colonic neoplasms.


Barrett’s metaplasia occurred more frequently among patients with hyperplastic polyps (OR = 2.14, 95 % CI 2.02–2.27), adenomatous polyps (2.52, 2.41–2.64), advanced adenomas (2.10, 1.90–2.32), villous adenomas or adenomas with high-grade (HG) dysplasia (2.45, 2.28–2.64), and colonic adenocarcinomas (1.75, 1.39–2.22). The association between Barrett’s metaplasia and colonic neoplasm applied similarly to polyps of different size, number and location within the large bowel. These types of association could also be confirmed when analyzed separately for Barrett’s metaplasia characterized by low-grade or HG dysplasia, as well as esophageal adenocarcinoma.


The data support the existence of a true association between Barrett’s metaplasia and various types of colonic neoplasm. The association may be more interesting for its potential insights into the pathogenesis of the two disorders than its actual clinical implications.


Barrett’s esophagus Colon polyps Gastroesophageal reflux disease Epidemiology of gastrointestinal disease Helicobacter pylori 



Confidence interval






Odds ratio




Conflict of interest

Robert M. Genta is employed by Miraca Life Sciences, Irving, TX, USA. Amnon Sonnenberg is supported by a grant from Takeda Pharmaceuticals. No funding was obtained for this study.


  1. 1.
    Sontag SJ, Schnell TG, Chejfec G, et al. Barrett’s oesophagus and colonic tumours. Lancet. 1985;1:946–949.PubMedCrossRefGoogle Scholar
  2. 2.
    Howden CW, Hornung CA. A systematic review of the association between Barrett’s esophagus and colon neoplasms. Am J Gastroenterol. 1995;90:1814–1819.PubMedGoogle Scholar
  3. 3.
    Siersema PD, Yu S, Sahbaie P, et al. Colorectal neoplasia in veterans is associated with Barrett’s esophagus but not with proton-pump inhibitor or aspirin/NSAID use. Gastrointest Endosc. 2006;63:581–586.PubMedCrossRefGoogle Scholar
  4. 4.
    Bollschweiler E, Schloesser T, Leers J, Vallböhmer D, Schäfer H, Hölscher AH. High prevalence of colonic polyps in white males with esophageal adenocarcinoma. Dis Colon Rectum. 2009;52:299–304.PubMedCrossRefGoogle Scholar
  5. 5.
    de Jonge PJ, van Blankenstein M, Looman CW, Casparie MK, Meijer GA, Kuipers EJ. Risk of colorectal cancer in patients with Barrett’s esophagus: a Dutch population-based study. Am J Gastroenterol. 2010;105:77–83.PubMedCrossRefGoogle Scholar
  6. 6.
    Poorman JC, Lieberman DA, Ippoliti AF, Weber LJ, Weinstein WM. The prevalence of colonic neoplasia in patients with Barrett’s esophagus: prospective assessment in patients 50–80 years old. Am J Gastroenterol. 1997;92:592–596.PubMedGoogle Scholar
  7. 7.
    Laitakari R, Laippala P, Isolauri J. Barrett’s oesophagus is not a risk factor for colonic neoplasia: a case–control study. Ann Med. 1995;27:499–502.PubMedCrossRefGoogle Scholar
  8. 8.
    Lagergren J, Nyren O. No association between colon cancer and adenocarcinoma of the oesophagus in a population based cohort study in Sweden. Gut. 1999;44:819–821.PubMedCrossRefGoogle Scholar
  9. 9.
    Murphy SJ, Anderson LA, Mainie I, et al. Incidence of colorectal cancer in a population-based cohort of patients with Barrett’s oesophagus. Scand J Gastroenterol. 2005;40:1449–1453 (erratum in: Scand J Gastroenterol. 2006;41:247).Google Scholar
  10. 10.
    Solaymani-Dodaran M, Logan RF, West J, Card T, Coupland C. Risk of extra-oesophageal malignancies and colorectal cancer in Barrett’s oesophagus and gastro-oesophageal reflux. Scand J Gastroenterol. 2004;39:680–685.PubMedCrossRefGoogle Scholar
  11. 11.
    Schouten LJ, Steevens J, Huysentruyt CJ, et al. Total cancer incidence and overall mortality are not increased among patients with Barrett’s esophagus. Clin Gastroenterol Hepatol. 2011;9:754–761.PubMedCrossRefGoogle Scholar
  12. 12.
    Cook MB, Wild CP, Everett SM, et al. Risk of mortality and cancer incidence in Barrett’s esophagus. Cancer Epidemiol Biomarkers Prev. 2007;16:2090–2096.PubMedCrossRefGoogle Scholar
  13. 13.
    Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International workshop on the histopathology of gastritis, Houston 1994. Am J Surg Pathol. 1996;20:1161–1181.PubMedCrossRefGoogle Scholar
  14. 14.
    Srivastava A, Odze RD, Lauwers GY, Redston M, Antonioli DA, Glickman JN. Morphologic features are useful in distinguishing Barrett esophagus from carditis with intestinal metaplasia. Am J Surg Pathol. 2007;31:1733–1741.PubMedCrossRefGoogle Scholar
  15. 15.
    Winawer SJ, Zauber AG. The advanced adenoma as the primary target of screening. Gastrointest Endosc Clin N Am. 2002;12:1–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Sonnenberg A, Amorosi LS, Lacey MJ, Lieberman DA. Patterns of endoscopy in the United States: analysis of data from the Centers for Medicare and Medicaid Services and the National Endoscopic Database. Gastrointest Endosc. 2008;67:489–496.PubMedCrossRefGoogle Scholar
  17. 17.
    Sontag S. The Colono–Barrett relationship: a tie that will not die. Gastrointest Endosc. 2006;63:587–589.PubMedCrossRefGoogle Scholar
  18. 18.
    Samanic C, Chow WH, Gridley G, Jarvholm B, Fraumeni JF Jr. Relation of body mass index to cancer risk in 362,552 Swedish men. Cancer Causes Control. 2006;17:901–909.PubMedCrossRefGoogle Scholar
  19. 19.
    Corley DA, Kubo A, Levin TR, et al. Abdominal obesity and body mass index as risk factors for Barrett’s esophagus. Gastroenterology. 2007;133:34–41.PubMedCrossRefGoogle Scholar
  20. 20.
    Lagergren J. Influence of obesity on the risk of esophageal disorders. Nat Rev Gastroenterol Hepatol. 2011;8:340–347.PubMedCrossRefGoogle Scholar
  21. 21.
    Bernstein H, Bernstein C, Payne CM, Dvorak K. Bile acids as endogenous etiologic agents in gastrointestinal cancer. World J Gastroenterol. 2009;15:3329–3340.PubMedCrossRefGoogle Scholar
  22. 22.
    McQuaid KR, Laine L, Fennerty MB, Souza R, Spechler SJ. Systematic review: the role of bile acids in the pathogenesis of gastro-oesophageal reflux disease and related neoplasia. Aliment Pharmacol Ther. 2011;34:146–165.PubMedCrossRefGoogle Scholar
  23. 23.
    Thorburn CM, Friedman GD, Dickinson CJ, Vogelman JH, Orentreich N, Parsonnet J. Gastrin and colorectal cancer: a prospective study. Gastroenterology. 1998;115:275–280.PubMedCrossRefGoogle Scholar
  24. 24.
    Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10–29.PubMedCrossRefGoogle Scholar
  25. 25.
    Trivers KF, Sabatino SA, Stewart SL. Trends in esophageal cancer incidence by histology, United States, 1998–2003. Int J Cancer. 2008;123:1422–1428.PubMedCrossRefGoogle Scholar
  26. 26.
    American Gastroenterological Association, Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ. American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology. 2011;140:1084–1091.PubMedCrossRefGoogle Scholar
  27. 27.
    Wani S, Falk G, Hall M, et al. Patients with nondysplastic Barrett’s esophagus have low risks for developing dysplasia or esophageal adenocarcinoma. Clin Gastroenterol Hepatol. 2011;9:220–227.PubMedCrossRefGoogle Scholar
  28. 28.
    Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology. 2008;134:1570–1595.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York (Outside the USA) 2013

Authors and Affiliations

  1. 1.GastroenterologyPortland VA Medical Center P3-GIPortlandUSA
  2. 2.Oregon Health and Science UniversityPortlandUSA
  3. 3.Miraca Life SciencesIrvingUSA
  4. 4.University of Texas Southwestern Medical CenterDallasUSA
  5. 5.Dallas VA Medical CenterDallasUSA

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