Secular trends in the epidemiology and outcome of Barrett's oesophagus in Olmsted County, Minnesota

Background-The incidence of oesophageal adenocarcinoma has increased greatl y. Barrett's oesophagus is a known risk factor. Aims-To identify changes in the incidence, prevalence, and outcome of Barre tt's oesophagus in a defined population. Subjects-Residents of Olmsted Coun ty, Minnesota, with clinically diagnosed Barrett's oesophagus, or oesophage al or oesophagogastric junction adenocarcinoma. Methods-Cases were identified using the Rochester Epidemiology Project medi cal records linkage system. Records were reviewed with follow up to 1 Janua ry 1998. Results-The incidence of clinically diagnosed Barrett's oesophagus (>3 cm) increased 28-fold from 0.37/100 000 person years in 1965-69 to 10. 5/100 000 in 1995-97. Of note, gastroscopic examinations increased 22-fold in this same time period. The prevalence of diagnosed Barrett's oesophagus increased from 22.6 (95% confidence interval (CI) 11.7-33.6) per 100 000 in 1987 to 82.6/100 000 in 1998. The prevalence of short segment Barrett's oe sophagus (<3 cm) in 1998 was 33.4/100 000. Patients with Barrett's oesophag us had shorter than expected survival but only one patient with Barrett's o esophagus died from adenocarcinoma. Only four of 64 adenocarcinomas occurre d in patients with previously known Barrett's oesophagus. Conclusions-The incidence and prevalence of clinically diagnosed Barrett's oesophagus have increased in parallel with the increased use of endoscopy. We infer that the true population prevalence of Barrett's oesophagus has no t changed greatly, although the incidence of oesophageal adenocarcinoma inc reased 10-fold. Many adenocarcinomas occurred in patients without a previou s diagnosis of Barrett's oesophagus, suggesting that many people with this condition remain undiagnosed in the community.