Multicentre prospective controlled study of Barrettʹs oesophagus and colorectal adenomas

Previous studies have suggested that patients with Barrettʹs oesophagus may be at increased risk of colorectal neoplasia, though the association is disputed. In a multicentre prospective study we compared the prevalence of colorectal adenomas in patients with Barrettʹs oesophagus and controls. Barrettʹs oesophagus patients (n=104) had histological confirmation of columnar epithelium extending more than 3 cm above the gastro-oesophageal junction. The 537 controls were patients with symptoms suggesting irritable bowel syndrome. No participant had a personal history of colonic neoplasm. Each patient underwent colonoscopy. Histologically proven adenomas were found in 26 Barrettʹs patients (25%) and 75 controls (14%). Three colorectal cancers were discovered in each group. The prevalence of adenomas was greater in the Barrettʹs oesophagus group than in the control group (p<0·01) but the relation became non-significant after adjustment for age and sex and control for other known risk factors by a logistic regression model (odds ratio 1·4 [0·7-2·7]). The relative risk of adenoma was significantly higher in patients older than 59 than in younger patients (2·2 [1·3-3·5]) and in men than in women (3·4 [2·0-5·7]). Other factors contributing significantly to the risk of adenoma were a family history of colorectal cancer (2·3 [1·1-4·8]), rectal bleeding (2·1 [1·1-3·9]), previous colonic investigation (0·3 [0·1-0·7]), and complete as opposed to partial colonoscopy (6·4 [0·8-48·3]). We conclude that Barrettʹs oesophagus is not an independent risk factor for colorectal neoplasia and, therefore, is not, in itself an indication for colorectal screening.