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Distal esophageal acid exposure and poor esophageal clearance correlate with probability of progression in Barrett’s esophagus
Journal article   Open access   Peer reviewed

Distal esophageal acid exposure and poor esophageal clearance correlate with probability of progression in Barrett’s esophagus

Sven E Eriksson, Jennifer M. Kolb, Johnathan Nguyen, Inanc S Sarici, Ping Zheng and Shahin Ayazi
Surgical endoscopy : ultrasound and interventional techniques
07 Jul 2025
DOI: https://doi.org/10.1007/s00464-025-11930-y
PMID: 40624426
Featured in Collection :   Research Supported by Drexel Libraries' OA Programs
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https://doi.org/10.1007/s00464-025-11930-yView
Published, Version of Record (VoR)Open Access via Drexel Libraries Read and Publish Program 2025CC BY V4.0,  Open

Abstract

Barrett's esophagus Esophageal pH-monitoring High-resolution manometry Progression Dysplasia Biomarkers Gastroenterology
Background The risk of progression from non-dysplastic Barrett’s esophagus (NDBE) to high grade dysplasia or esophageal adenocarcinoma (HGD/EAC) is low but variable. Biomarker assays can aid with risk stratification to optimize surveillance for NDBE. The role of diagnostic esophageal testing in prognosticating progression is unclear. The aim of this study was to evaluate whether esophageal physiology parameters correlate with a validated biomarker for BE risk progression. Methods Patients with NDBE, including histology confirmed intestinal metaplasia < 1 cm, had their pathology specimen analyzed using a validated tissue systems pathology test with 9 biomarkers (TSP-9). This assay uses immunohistochemistry and digital pathology analysis to provide a 5-year risk of progression to HGD/EAC. These patients also underwent esophageal pH-monitoring and high-resolution impedance manometry (HRIM). Correlation analyses were performed between TSP-9 risk percent and esophageal testing. Results A total of 59 patients [52.5% male; mean (SD) age 59 (14)] were included (40 NDBE, 19 < 1 cm IM) between 2021 and 2023. The median (IQR) TSP-9 value for 5-year risk of progression was low at 2.0% (2.0–3.0%). There were 8 (13.6%) statistical outliers with higher risk ranging from 5.0 to 10.0%. Risk of progression in the entire cohort was directly correlated with physiology testing parameters including DeMeester score (R = 0.30), acid exposure time (AET) (R = 0.34), duration of longest reflux episode on pH-monitoring (R = 0.30), and % incomplete bolus clearance on HRIM (R = 0.35) (p < 0.05 for all). In a subgroup of 19 patients with < 1 cm IM, risk of progression had a stronger correlation with DeMeester score (R = 0.65), AET (R = 0.67), supine AET (R = 0.70), number of reflux episodes on pH-monitoring (R = 0.50) and % incomplete bolus clearance on HRIM (R = 0.68) (p < 0.05 for all). Conclusion There was a direct correlation between 5-year risk of progression to HGD/EAC using TSP-9 and distal esophageal acid exposure and poor esophageal clearance among patients with NDBE that was even stronger in those with < 1 cm of IM. These findings suggest that esophageal physiology testing may have value in predicting risk progression in BE.

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Collaboration types
Domestic collaboration
Web of Science research areas
Surgery
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