P2408 - Prevalence of Barrett’s Esophagus Is Increased Among GERD Patients Receiving Immunosuppressive Therapy: A Nationwide Population-Based Study

Ahmed Eltelbany, MD, MPH¹, Osama Hamid, MD¹, Abdul Mohammed, MD², George Khoudari, MD¹, Madhusudan Sanaka, MD¹, Prashanthi N. Thota, MD^1
1Cleveland Clinic Foundation, Cleveland, OH; ²MetroHealth Medical Center, Cleveland, OH

Introduction: Barrett’s esophagus (BE) is a common condition, and is the precursor to esophageal adenocarcinoma, a disease with increasing burden in the USA. Risk factors include GERD, obesity and tobacco smoking. However, the connection between an altered host immune surveillance and the development of Barret’s esophagus is not clear. The aim of this study is to assess prevalence of Barrett’s esophagus in GERD patients receiving immunosuppressive therapy.

Methods: We reviewed data from a large commercial database (Explorys IBM) that aggregates electronic health records from 26 large nationwide healthcare systems. Using systemized nomenclature of clinical medical terms (SNOMED CT), we identified patients with GERD on immunosuppressant and/or immunomodulators regardless of indication excluding patients with the diagnosis of esophageal cancer. In this cohort, we identified demographic data like gender, age, race as well as smoking status. We further looked into subgroup of immunosupressants like Calcinurin inhibitors, Macrolide immunosupressants, Monoclonal antibody and Selective adhesion molecule inhibitor.Also identified immunomodulator like Anti-TNF alpha, INF alpha, IL inhbitiors. We used R version 3.6.3 for statistical analysis.

Results: Out of 62.7 million active adult patients in the database, 431600 (0.69%) were GERD patients on immunosuppressant or immunomodulators. 68% of this cohort are females and the vast majority were Caucasian (83%). Univariate analysis revealed that GERD patients on immunosuppressant and/or immunodulator therapy have higher prevalence of BE in comparison to patients with GERD only OR 1.31 [95% CI 1.29-1.33]. On subgroup immunosuppressant analysis, Calcineurin inhibitor OR 1.44 [95% CI 1.41 - 1.49], Macrolide immunosuppressants OR 1.22 [95% CI 1.17 - 1.27]), Monoclonal antibody OR 1.45 [95% CI 1.42 - 1.49]), and selective adhesion molecule inhibitors OR 1.40 [95% CI 1.21 - 1.62])

Discussion: Our findings show that patients with GERD who are on immunosuppressive therapy have a higher risk of developing BE compared to patients with GERD only. Though these observations are limited, they suggest that patients on immunosuppressive therapy would benefit from screening for BE.



Disclosures:


Ahmed Eltelbany, MD, MPH¹, Osama Hamid, MD¹, Abdul Mohammed, MD², George Khoudari, MD¹, Madhusudan Sanaka, MD¹, Prashanthi N. Thota, MD¹. P2408 - Prevalence of Barrett’s Esophagus Is Increased Among GERD Patients Receiving Immunosuppressive Therapy: A Nationwide Population-Based Study, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.