S866 Assessment of Major Risk Factors Influencing the Presence of Dysplasia in Patients with Barrett's Esophagus in Mexican Population

Introduction: In developed countries, esophageal adenocarcinoma (EAC) has emerged as the predominant histologic subtype, mirroring significant lifestyle and environmental shifts that are reshaping global incidence trends. This malignancy typically originates in the distal esophagus through a well-defined sequence from Barrett's esophagus (BE) to dysplasia and, ultimately, invasive carcinoma. Because EAC is usually diagnosed at a less treatable stage, advancing this understanding is critical to optimizing targeted screening strategies to improve early detection, when therapeutic interventions are most effective. Methods: We included patients with a diagnosis of BE, confirmed through both endoscopic visualization and histopathological analysis, who were evaluated at the gastrointestinal endoscopy unit of Hospital Juárez de México between 2023 and 2025. The tests used for group comparison were Chi-square, Student's t test, and Mann-Whitney U test. Finally, a binary logistic regression was performed, and a P-value of < 0.05 was taken as statistically significant. Results: Of 81 patients, 50 (61%) were men, with a mean age of 59.5 ± 12.9 years. A history of smoking was present in 45 patients (55%), and 57 (70%) reported symptoms of gastroesophageal reflux disease (GERD). Endoscopic evaluation revealed median Prague C and M scores of 2 (1-3) and 4 (3-6), respectively; nodularity was observed in 23 patients (28%), and hiatal hernia in 47 (58%). Biopsy showed dysplasia in 26 patients (32%) and EAC in 7 (8%). Compared to patients without dysplasia, those with dysplasia had significantly higher rates of smoking, greater pack-year exposure, and more frequent co-occurrence of smoking and GERD symptoms. Binary logistic regression identified independent risk factors for dysplasia: smoking (odds ratio [OR] 4.61; 95% confidence interval [CI] 1.48-14.29; P = 0.008), >30 pack-years (OR 9.94; 95% CI 3.09-31.98; P < 0.001), and combined smoking and GERD symptoms (OR 3.00; 95% CI 1.10-8.18; P = 0.033). Conclusion: Endoscopic screening is recommended for GERD patients with additional risk factors: male sex, age >50, obesity, or smoking as part of BE surveillance. In our Mexican cohort, GERD symptoms alone weren’t linked to dysplasia, but smoking combined with GERD symptoms tripled dysplasia risk. Moreover, smoking alone was associated with a 4-fold increase, and up to 10-fold with over 30 pack-years. These findings highlight smoking as the strongest modifiable risk factor for BE progression, emphasizing the urgent need for targeted cessation strategies.