Prevalence of Barrett's esophagus in the general population: an endoscopic study.

BACKGROUND & AIMS Barrett's esophagus (BE) is associated with esophageal adenocarcinoma, the incidence of which has been increasing dramatically. The prevalence of BE in the general population is uncertain because upper endoscopy is required for diagnosis. This study aimed to determine the prevalence of BE and possible associated risk factors in an adult Swedish population. METHODS A random sample (n = 3000) of the adult population (n = 21,610) in 2 municipalities was surveyed using a validated gastrointestinal symptom questionnaire (response rate, 74%); a random subsample (n = 1000; mean age, 53.5 years; 51% female) underwent upper endoscopy. Endoscopic signs suggestive of columnar-lined esophagus (CLE) were defined as mucosal tongues or an upward shift of the squamocolumnar junction. BE was diagnosed when specialized intestinal metaplasia was detected histologically in suspected CLE. RESULTS BE was present in 16 subjects (1.6%; 95% confidence interval, 0.8-2.4): 5 with a long segment and 11 with a short segment. Overall, 40% reported reflux symptoms and 15.5% showed esophagitis; 103 (10%) had suspected CLE, and 12 (1.2%) had a visible segment > or = 2 cm. The prevalence of BE in those with reflux symptoms was 2.3% and in those without reflux symptoms was 1.2% (P = .18). In those with esophagitis, the prevalence was 2.6%; in those without, the prevalence was 1.4% (P = .32). Alcohol (P = .04) and smoking (P = .047) were independent risk factors for BE. CONCLUSIONS BE was found in 1.6% of the general Swedish population. Alcohol and smoking were significant risk factors.

[1]  The incidence of adenocarcinoma and dysplasia in Barrett's esophagus: Report on the cleveland clinic barrett's esophagus registry , 1999 .

[2]  G. Falk.  Gastroesophageal Reflux Disease and Barrett's Esophagus , 2001, Endoscopy.

[3]  J R Bennett,et al.  The endoscopic assessment of esophagitis: a progress report on observer agreement. , 1996, Gastroenterology.

[4]  R. Wong,et al.  Specialized intestinal metaplasia, dysplasia, and cancer of the esophagus and esophagogastric junction: prevalence and clinical data. , 1999, Gastroenterology.

[5]  P. Malfertheiner,et al.  Prognostic influence of Barrett’s oesophagus and Helicobacter pylori infection on healing of erosive gastro-oesophageal reflux disease (GORD) and symptom resolution in non-erosive GORD: report from the ProGORD study , 2005, Gut.

[6]  R. Sandler,et al.  Is there publication bias in the reporting of cancer risk in Barrett's esophagus? , 2000, Gastroenterology.

[7]  S. Spechler.  The columnar-lined esophagus. History, terminology, and clinical issues. , 1997, Gastroenterology clinics of North America.

[8]  J. Mecklin,et al.  Complete and incomplete intestinal metaplasia at the oesophagogastric junction: prevalences and associations with endoscopic erosive oesophagitis and gastritis , 1999, Gut.

[9]  N. Seersholm,et al.  Adenocarcinoma of the esophagus and Barrett's esophagus: a population-based study , 1999, American Journal of Gastroenterology.

[10]  G. Lapertosa,et al.  Risk factors for Barrett's esophagus: A case‐control study , 2002, International journal of cancer.

[11]  A. Sonnenberg,et al.  Hiatal hernia size, Barrett's length, and severity of acid reflux are all risk factors for esophageal adenocarcinoma , 2002, American Journal of Gastroenterology.

[12]  S. McClave,et al.  Early diagnosis of columnar-lined esophagus: a new endoscopic diagnostic criterion. , 1987, Gastrointestinal endoscopy.

[13]  A. Cameron.  Barrett's esophagus: prevalence and size of hiatal hernia , 1998, American Journal of Gastroenterology.

[14]  K. Kerlikowske,et al.  Protective association of aspirin/NSAIDs and esophageal cancer: a systematic review and meta-analysis. , 2003, Gastroenterology.

[15]  G. Triadafilopoulos,et al.  Prevalence of Barrett's esophagus in asymptomatic individuals. , 2002, Gastroenterology.

[16]  A. Lindgren,et al.  Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. , 1999, The New England journal of medicine.

[17]  D. Armstrong.  Review article: towards consistency in the endoscopic diagnosis of Barrett's oesophagus and columnar metaplasia , 2004, Alimentary pharmacology & therapeutics.

[18]  M. Vieth,et al.  A negative Helicobacter pylori serology test is more reliable for exclusion of premalignant gastric conditions than a negative test for current H. pylori infection: A report on histology and H. pylori detection in the general adult population , 2005, Scandinavian journal of gastroenterology.

[19]  M. Vieth,et al.  Valid symptom reporting at upper endoscopy in a random sample of the Swedish adult general population: the Kalixanda study , 2004, Scandinavian journal of gastroenterology.

[20]  O. Cummings,et al.  Screening for Barrett's esophagus in colonoscopy patients with and without heartburn. , 2003, Gastroenterology.

[21]  S. McClave,et al.  Incomplete intestinal metaplasia in the diagnosis of columnar lined esophagus (Barrett's esophagus). , 1989, American Journal of Clinical Pathology.

[22]  A. Klauser,et al.  Symptoms in gastro-oesophageal reflux disease , 1990, The Lancet.

[23]  R. Haggitt.  Adenocarcinoma in Barrett's esophagus: a new epidemic? , 1992, Human pathology.

[24]  Janusz Jankowski,et al.  A critical review of the diagnosis and management of Barrett's esophagus: the AGA Chicago Workshop. , 2004, Gastroenterology.

[25]  M F Dixon,et al.  Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. , 1996, The American journal of surgical pathology.

[26]  D J Ballard,et al.  Prevalence of columnar-lined (Barrett's) esophagus. Comparison of population-based clinical and autopsy findings. , 1990, Gastroenterology.

[27]  S. Spechler,et al.  Clinical practice. Barrett's Esophagus. , 2002, The New England journal of medicine.

[28]  A. Astrup,et al.  Obesity : Preventing and managing the global epidemic , 2000 .

[29]  M. Vieth,et al.  High prevalence of gastroesophageal reflux symptoms and esophagitis with or without symptoms in the general adult Swedish population: A Kalixanda study report , 2005, Scandinavian journal of gastroenterology.

[30]  S. Spechler.  Columnar-lined esophagus. Definitions. , 2002, Chest surgery clinics of North America.

[31]  R. Stenling,et al.  The esophageal Z-line appearance correlates to the prevalence of intestinal metaplasia. , 2000, Scandinavian journal of gastroenterology.

[32]  P. Moayyedi,et al.  Esophageal adenocarcinoma arising from Barrett's metaplasia has regional variations in the west. , 2002, Gastroenterology.

[33]  P. Kahrilas.  Gastroesophageal reflux disease. , 1996, JAMA.

[34]  J. Fraumeni,et al.  Rising incidence of adenocarcinoma of the esophagus and gastric cardia. , 1991, JAMA.

[35]  A. Sonnenberg,et al.  Endoscopic evaluation of patients with dyspepsia: results from the national endoscopic data repository. , 2004, Gastroenterology.

[36]  E. Kuipers,et al.  Oesophageal cancer incidence and mortality in patients with long-segment Barrett's Oesophagus after a mean follow-up of 12.7 years , 2004, Scandinavian journal of gastroenterology.

[37]  A. Blum,et al.  Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification , 1999, Gut.

[38]  E. Funkhouser,et al.  Aspirin and reduced risk of esophageal carcinoma , 1995, Cancer.

[39]  J. Fraumeni,et al.  Changing patterns in the incidence of esophageal and gastric carcinoma in the United States , 1998, Cancer.

[40]  P. Malfertheiner,et al.  Risk factors of gastroesophageal reflux disease: methodology and first epidemiological results of the ProGERD study. , 2004, Journal of clinical epidemiology.

[41]  O. Nyrén,et al.  Reproducibility and validity of a postal questionnaire. The abdominal symptom study. , 1993, Scandinavian journal of primary health care.

[42]  J. Mecklin,et al.  Gastroesophageal Reflux Disease: Prevalence, Clinical, Endoscopic and Histopathological Findings in 1,128 Consecutive Patients Referred for Endoscopy due to Dyspeptic and Reflux Symptoms , 2000, Digestion.

[43]  M. Bains,et al.  Adenocarcinoma in Barrett's esophagus. , 1983, The Journal of thoracic and cardiovascular surgery.

[44]  S. Re,et al.  The incidence of adenocarcinoma in Barrett's esophagus: a prospective study of 170 patients followed 4.8 years. , 1997 .

[45]  P. Lavori,et al.  Use of a simple symptom questionnaire to predict Barrett's esophagus in patients with symptoms of gastroesophageal reflux. , 2001 .

[46]  I. Wiklund,et al.  Validation of the translation and cross-cultural adaptation into Finnish of the Abdominal Symptom Questionnaire, the Hospital Anxiety and Depression Scale and the Complaint Score Questionnaire , 2004, Scandinavian journal of gastroenterology.