Background and study aims: There is a view that the majority of deaths in patients with Barrett’s esophagus
are from causes other than esophageal adenocarcinoma (EAC). The aim of this analysis
was to establish the pattern of mortality for a number of causes in patients with
Barrett’s esophagus .
Patients and methods: This was a single-center prospective cohort study of patients from Rotherham District
General Hospital, which is a secondary referral center. The cohort consisted of 1239
patients who were diagnosed with Barrett’s esophagus between April 1978 and March
2009. Follow-up for mortality was undertaken by “flagging” the patients with the NHS
Information Center. Causes of death were compared with UK Office of National Statistics
age- and sex-specific mortality data for 1999, the median year of diagnosis. Analysis
was by a “person – years at risk” calculation from date of diagnosis.
Results: The ratio of observed deaths from EAC compared with those expected in this cohort
was 25.02 – a very large excess. There was no difference in mortality from colorectal
cancer or circulatory disease and there were fewer deaths from cancers other than
esophageal adenocarcinoma and colon cancer compared with national statistics. There
was a small statistically significant difference in mortality from all causes but
this disappeared completely when deaths from esophageal adenocarcinoma were excluded.
Conclusions: Overall, mortality in Barrett’s esophagus is increased significantly but only as
a result of the large excess of deaths from EAC. This strengthens the case for endoscopic
surveillance if successful interventions can be undertaken in patients with Barrett’s
esophagus to prevent development of esophageal adenocarcinoma.
