Low Risk of Progression of Barrett's Esophagus to Neoplasia in Women

James E. Allen, Madhav Desai, Carlijn A.M. Roumans, Sreekar Vennalaganti, Prashanth Vennalaganti, Ajay Bansal, Gary Falk, David Lieberman, Richard Sampliner, Prashanthi Thota, John Vargo, Neil Gupta, Fouad Moawad, Marco Bruno, Kevin F. Kennedy, Srinivas Gaddam, Patrick Young, Sharad Mathur, Brooks Cash, Manon SpaanderPrateek Sharma*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background and Aims: Men are at a higher risk for Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC), but little is known about BE progression to dysplasia and EAC in women. We performed a retrospective, multicenter cohort study to assess risk of BE progression to dysplasia and EAC in women compared with men. We also investigated comorbidities, medication use, and endoscopic features that contribute to sex differences in risk of BE progression. Methods: We collected data from large cohort of patients with BE seen at 6 centers in the United States and Europe, followed for a median 5.7 years. We obtained demographic information (age, sex, ethnicity), clinical history (tobacco use, body mass index, comorbidities), endoscopy results (procedure date, BE segment length), and histopathology findings. Neoplasia was graded as low-grade dysplasia, high-grade dysplasia (HGD), or EAC. Rates of disease progression between women and men were compared using χ2analysis and the Student t test. Multivariable logistic regression was used to assess the association between sex and disease progression after adjusting for possible confounding variables. Results: Of the total 4263 patients in the cohort, 2145 met the inclusion criteria, including 324 (15%) women. There was a total of 34 (1.6%) incident EACs, with an overall annual incidence of 0.3% (95% confidence interval: 0.2%-0.4%). We found significant differences between women and men in annual incidence rates of EAC (0.05% for women vs. 0.3% in men; P=0.04) and in the combined endpoint of HGD or EAC (0.1% for women vs. 1.1% for men; P<0.001). Female gender was an independent predictor for reduced progression to HGD or EAC when rates of progression were adjusted for body mass index, smoking history, race, use of aspirin, nonsteroidal anti-inflammatory drugs, proton-pump inhibitors, or statins, hypertriglyceridemia, BE length, and histology findings at baseline (hazard ratio: 0.11; 95% confidence interval: 0.03-0.45; P=0.002). Conclusions: In a multicenter study of men versus women with BE, we found a significantly lower risk of disease progression to cancer and HGD in women. The extremely low risk of EAC in women with BE (0.05%/y) indicates that surveillance endoscopy may not be necessary for this subgroup of patients with BE.

Original languageEnglish
Pages (from-to)321-326
Number of pages6
JournalJournal of Clinical Gastroenterology
Issue number4
StatePublished - Apr 2021
Externally publishedYes


  • Barrett's esophagus
  • adenocarcinoma
  • gender disparity


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