Histopathological Evolution of Barrett’s Esophagus over a 12-Year Period: Insights from a Gastroenterology Clinic in Kashan, Iran

Abstract

Background:

Barrett’s esophagus (BE) is a premalignant condition that increases the risk of esophageal adenocarcinoma (EAC). Data on the natural history and histopathological changes of BE in Middle Eastern populations remain limited. This study aimed to evaluate the longitudinal course and prognostic factors of BE in an Iranian cohort over a 12-year period.

Materials and Methods:

We conducted a retrospective cohort study of patients with histologically confirmed BE who attended the Gastroenterology Clinic of Shahid Beheshti Hospital, Kashan, between 2011 and 2023. Eligible patients had undergone at least two endoscopic evaluations with biopsy. We extracted demographic, clinical, and lifestyle data, and classified histopathology as short-segment BE (SSBE), long-segment BE (LSBE), low-grade dysplasia (LGD), high-grade dysplasia (HGD), or EAC. We categorized outcomes as regression, stability, or progression. Statistical analyses were performed using Chi-square, Fisher’s exact test, and ANOVA.

Results:

We included 87 patients (56.3% men; mean age 50.5 ± 18.6 years). At baseline, SSBE was more frequent than LSBE (70.1% vs. 29.9%). During follow-up, 16.1% of patients achieved complete regression, 34.5% showed overall improvement (complete or partial), 59.8% remained stable, and 5.7% progressed to LGD. Notably, all progressions occurred in LSBE, whereas no patient with SSBE developed dysplasia. Helicobacter pylori (H. pylori) infection was significantly associated with favorable outcomes (P=0.014), and longer surveillance intervals were linked to higher regression rates (P=0.014). Smoking and unhealthy diet were highly prevalent but not significantly associated with progression.

Conclusion:

Most patients with BE remained stable during long-term follow-up, with regression observed predominantly in SSBE and progression confined to LSBE. These findings highlight the indolent nature of SSBE, the higher malignant potential of LSBE, and the possible protective role of H. pylori. Risk-based surveillance, particularly more intensive monitoring of patients with LSBE, remains essential. Prospective studies integrating molecular biomarkers are warranted to refine risk stratification and optimize patient management.