Adiponectin may modify the risk of Barrett’s esophagus in patients with gastroesophageal reflux disease

Abstract

Background & Aims

Abdominal obesity and increasing body mass index are risk factors for esophageal adenocarcinoma and its main precursor, Barrett’s esophagus; however, there are no known biological mechanisms for these associations or regarding why only some patients with gastroesophageal reflux disease develop Barrett’s esophagus. We evaluated the association between Barrett’s esophagus and multimers of an adipose-associated hormone, adiponectin.

Methods

We conducted a case-control study evaluating the associations between adiponectin (total, high molecular weight, and low/medium molecular weight) and Barrett’s esophagus within the Kaiser Permanente Northern California population. Patients with a new diagnosis of Barrett’s esophagus (cases) were matched to patients with gastroesophageal reflux disease (GERD) without Barrett’s esophagus and to population controls.

Results

Complete serologic and epidemiologic data were available for 284 cases, 294 GERD controls, and 285 population controls. Increasing adiponectin levels were a risk factor for Barrett’s esophagus among patients with gastroesophageal reflux disease (total adiponectin fourth vs. first quartile odds ratio [OR]=1.96; 95% confidence interval (CI) 1.17–3.27; high molecular weight adiponectin OR=1.65; 95% CI 1.00–2.73; low/medium molecular weight adiponectin OR=2.18; 95% CI 1.33–3.56, but not compared with population controls. The associations were significantly stronger among patients reporting frequent GERD symptoms and among smokers (p-values interaction <0.01).

Conclusion

Adiponectin levels are positively associated with the risk of Barrett’s esophagus among patients with GERD and among smokers, but not among population controls without GERD symptoms. Higher adiponectin concentrations may either independently contribute to the aberrant healing of esophageal injury into Barrett’s esophagus or be a marker for other factors.