Kurzfassung

Background Barrett's esophagus (BE) is the main precursor of esophageal adenocarcinoma (similar to 2% prevalence in Western adults). Steatotic liver disease (SLD), affecting similar to 25% of adults, is linked to systemic inflammation, but its relationship with BE is unclear.Methods In the population-based Salzburg Colon Cancer Prevention Initiative (2007-2020), we analyzed 5507 asymptomatic screening participants. SLD was diagnosed by ultrasound and classified as MASLD or MetALD; BE was confirmed endoscopically and histologically. Associations were assessed using multivariable logistic regression adjusting for demographic, metabolic, and clinical factors.Results SLD was present in 2550 participants and clustered with diabetes and metabolic syndrome. BE was found in 62 individuals (1.0% without SLD, 1.5% with MASLD, 1.1% with MetALD; P = 0.28). After adjustment, MASLD (OR 1.28; 95% CI 0.74-2.21) and MetALD (OR 0.66; 95% CI 0.16-2.85) were not significantly associated with BE. Female sex was protective (OR 0.26; 95% CI 0.13-0.50), while hiatal hernia increased BE risk (OR 2.05; 95% CI 1.16-3.60).Conclusion In this population-based cohort, MASLD and MetALD were not clearly associated with BE. Current data do not support incorporating SLD status into BE screening algorithms, although modest risk increases cannot be ruled out.