C0215 - Association of Esophageal Inlet Patch to Barrett’s Esophagus: Analysis of Risk Factors, High Resolution Esophageal Manometry (HREM) and Esophageal pH-Impedance (EpHI) Results

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Rishabh Khatri, MD

Temple University Hospital
Philadelphia, PA

Rishabh Khatri, MD¹, Jay B. Patel, MD¹, Jun Song, MD¹, Zubair Malik, MD¹, Michael S. Smith, MD, MBA², Henry P. Parkman, MD³
¹Temple University Hospital, Philadelphia, PA; ²Mount Sinai Morningside and Mount Sinai West Hospitals, New York, NY; ³Temple University Health System, Philadelphia, PA

Introduction: Esophageal gastric heterotopia or Inlet Patch (IP) is thought to be embryologic in nature. Barrett’s Esophagus (BE) results from reflux. Though IP has been associated with BE in several studies, their relationship is not well defined. The aim of this study is to investigate the potential HREM, EpHI, and risk factor relationships between IP and BE.

Methods: All endoscopic, HREM and EpHI data for patients age ≥ 18 years who had EGD from January 2010 to December 2020 at a single high-volume motility center were reviewed. Patients were grouped by presence or absence of IP and/or BE on EGD. Age, sex, BMI, race, alcohol and tobacco use were recorded. ANOVA and t-test were used to calculate differences in HREM and EpHI testing. A multivariate regression model was constructed to identify independent variables associated with presence of IP and BE.

Results: Of 27,598 unique eligible patients who underwent EGD during the study period, 1,294 (4.7%) had endoscopic evidence of BE; 362 (1.3%) had IP, of whom 62 (17.1%) had both IP and BE (p< 0.001). Patients with BE alone, IP alone, and both BE and IP were older and had higher BMI than those without either finding (p< 0.001). HREM was normal in 50% of patients with BE alone, 54% of patients with IP alone, 52% of patients with IP and BE (p< 0.05). Mean lower esophageal sphincter (LES) residual pressure was lower in patients with BE and/or IP when compared to those without either (p< 0.05). EpHI testing was normal in 12% of patients with BE, 32% of patients with IP, 15% of patients with both IP and BE (p< 0.05). Mean acid exposure time (AET) was higher in patients with BE and/or IP than those without (p< 0.001) [Figure 1]. On multivariate regression analysis, patients with only BE, only IP, and both IP and BE were all independently associated with increasing age and BMI, male sex, Caucasian race, Hispanic ethnicity, and current smoking [Table 1].

Discussion: In our upper endoscopy database, BE was seen in 4.7%, IP in 1.3%, with 17% of IP patients also having BE. Patients with BE alone, IP alone, and both IP and BE were found to be older, have higher BMI, lower LES residual pressure, and higher AET when compared to those without either endoscopic finding. Factors such as male sex, BMI, Caucasian race, active smoking status were independently associated with BE alone, IP alone, and IP and BE findings. Endoscopic testing and risk factor analysis in individuals with these risk factors should be performed with careful esophageal inspection for both BE and IP.

Figure: Figure 1: Differences in Mean High Resolution Esophageal Manometry (HREM) and Esophageal pH-Impedance (EpHI) Testing Characteristics in Patients With and Without Barrett’s Esophagus (BE) and Inlet Patch (IP)
[BLUE: Patients without BE or IP; ORANGE: Patients with BE Only; GRAY: Patients with IP Only; YELLOW: Patients with Both BE and IP]

	Patients with only Barrett’s Esophagus			Patients with only Inlet Patch			Patients with Both Inlet Patch and Barrett’s Esophagus
Factors	OR	95% CI	p-Value	OR	95% CI	p-Value	OR	95% CI	p-Value
Age
	1.02	1.02-1.03	< 0.001	1.04	1.04-1.05	< 0.001	1.05	1.05-1.06	< 0.001
BMI
	1.20	1.20-1.21	< 0.001	1.02	1.01-1.02	< 0.001	1.11	1.09-1.11	< 0.001
Sex
Female	Ref	-	-	-	-	-	-	-	-
Male	2.22	1.96-2.51	< 0.001	1.47	1.16-1.85	< 0.001	1.30	1.29-1.31	< 0.001
Race
African American	Ref	-	-	-	-	-	-	-	-
Hispanic	1.17	1.01- 1.37	< 0.001	1.65	1.19 -2.29	< 0.001	1.12	1.11-1.14	< 0.001
Caucasian	1.87	1.64- 2.15	< 0.001	2.51	1.86- 3.39	< 0.001	1.68	1.67-1.70	< 0.001
Asian	0.66	0.40- 1.09	0.11	0.33	0.22-0.45	0.17	0.89	0.75-0.92	0.54
Smoking Status
Non-Smoking	Ref	-	-	-	-	-	-	-	-
Current Smoker	1.02	1.02-1.03	< 0.001	1.12	1.11-1.13	< 0.001	1.08	1.07-1.10	< 0.001
Alcohol Status
Non-Alcohol Drinker	Ref	-	-	-	-	-	-	-	-
Current Alcohol Drinker	0.46	0.28-0.76	< 0.001	0.83	0.65-1.05	0.12	0.82	0.88-1.05	0.55

Table: Table 1: Multivariate Regression of Risk Factors for Barrett’s Esophagus-Only Patients vs Those With Only Inlet Patch vs Those with BE and IP

Disclosures:

Rishabh Khatri indicated no relevant financial relationships.

Jay Patel indicated no relevant financial relationships.

Jun Song indicated no relevant financial relationships.

Zubair Malik indicated no relevant financial relationships.

Michael Smith: Castle Biosciences – Advisory Committee/Board Member. CDx Diagnostics – Advisory Committee/Board Member, Consultant. GI Supply – Consultant. Lucid Diagnostics – Advisory Committee/Board Member, Consultant. Steris Endoscopy – Consultant.

Henry Parkman indicated no relevant financial relationships.

Rishabh Khatri, MD¹, Jay B. Patel, MD¹, Jun Song, MD¹, Zubair Malik, MD¹, Michael S. Smith, MD, MBA², Henry P. Parkman, MD³. C0215 - Association of Esophageal Inlet Patch to Barrett’s Esophagus: Analysis of Risk Factors, High Resolution Esophageal Manometry (HREM) and Esophageal pH-Impedance (EpHI) Results, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.