SAN DIEGO—The risk of developing Barrett’s esophagus and esophageal adenocarcinoma increases with severity of obesity, according to a new study presented at DDW 2025.

Obesity is a well-known risk factor for gastroesophageal reflux disease, but a retrospective study of 906,023 patients over a decade found that individuals with both obesity and GERD have an even higher risk of developing BE and EAC (abstract Su1316). Although the link between increasing body mass index and cardiovascular disease is well established, there were limited data prior to the study connecting the severity of obesity to BE and EAC risk.

“BE is the only known precursor to EAC. However, most patients diagnosed with EAC have never been diagnosed with BE, underscoring the need for better screening strategies for BE in the general population,” said Kevin P. Shah, MD, the study’s lead author and chief gastroenterology fellow at Northwestern University Feinberg School of Medicine, in Chicago. The study was conducted under the leadership of principal investigator Sri Komanduri, MD, MS, the associate chief of the Division of Gastroenterology and Hepatology at Northwestern.

The initial analysis consisted of patients with a BMI of 30 kg/m2 or higher treated across 11 hospitals in the Northwestern Medicine healthcare system between October 2014 and October 2024. Obesity was categorized as class I (BMI, 30-34.9 kg/m2), class II (BMI, 35-39.9 kg/m2) or class III (BMI, 40-60 kg/m2). GERD was defined as use of an acid-suppressive medication or an ICD-9/-10 diagnosis. The researchers excluded patients with any of the following: initial, final or maximum BMI greater than 60 kg/m2; initial BMI less than 25 kg/m2 or final BMI less than 18.5 kg/m2; and initial, final or maximum hemoglobin A1c of less than 4% or greater than 20%. Overall, 52% had class I obesity, 26.62% had class II obesity and 21.4% had class III obesity.

After the research team accounted for demographic variables such as age, sex and race, they found that patients with class III obesity had nearly double the odds of developing BE/EAC compared with those with milder obesity (class I obesity). 

“GERD was the strongest risk factor, associated with more than a 13-fold increase in the odds of developing BE/EAC among patients with obesity.” In addition, Dr. Shah said, “diabetes, smoking and alcohol use were significantly associated with an increased risk of BE/EAC, each approximately doubling the odds of disease.” 

The investigators also found that increased severity of obesity was linked to increased use of proton pump inhibitors. Patients with class III obesity also were more likely to have undergone anti-reflux surgery and to be prescribed glucagon-like peptide-1 receptor agonists.

“These findings highlight the need for improved and targeted screening strategies for BE and EAC in patients with obesity, with the goal of catching these patients earlier in their disease course, prior to progression to advanced cancer,” Dr. Shah said.

Julian Abrams, MD, MS, a professor of medicine and epidemiology in the Division of Digestive and Liver Diseases at Columbia University Irving Medical Center, in New York City, commended the researchers for exploring the associations between obesity and BE and EAC in a large health network. 

“Using clinical data and diagnosis codes extracted from the medical records, the authors found a significantly increased odds of BE or EAC in patients with BMI greater than 35,” Dr. Abrams said. “The findings from this study are consistent with several prior observational studies reporting an increased risk of both BE and EAC in obese individuals.”

Dr. Abrams, who was not involved in the study, added that “obesity is an independent risk factor for both BE and EAC, and weight-loss interventions may have the potential to reduce the risk of these diseases in obese individuals.”

—Susan Kreimer

Dr. Abrams reported financial relationships with Cyted Health, Exact Sciences and Pentax Medical. Dr. Shah reported no relevant financial disclosures.