Epidemiology and significance of Barrett's esophagus

Barrett's esophagus (BE) is of interest because of its recognized associati on with esophageal adenocarcinoma. While BE develops in a minority of patie nts with gastroesophageal reflux disease, its diagnosis has markedly increa sed over the last 30 years. Although a concurrent increase in the number of endoscopies performed annually has improved the ability to diagnose BE, th e increase in prevalence appears to be a true finding. Conflicting data in the literature confound an accurate assessment of the risk for adenocarcino ma in patients with BE. Certain factors associated with BE also hold for es ophageal adenocarcinoma: greater severity of reflux symptoms, specific patt ern of symptoms (particularly nocturnal), longer duration of symptoms, whit e race, and male gender. One report has suggested a 45-fold increase in can cer risk for patients with frequent, severe and long-standing heartburn sym ptoms. New cases of esophageal adenocarcinoma are also increasing, especial ly in white males, with over 6,000 new cases diagnosed in 1995. BE can prog ress to esophageal dysplasia a nd adenocarcinoma; hence, early diagnosis an d surveillance of BE and treatment of high-grade dysplasia leads to improve d survival. The reported risk of developing cancer in BE ranges from 0.4 to 1.9%/year of follow-up. Most recent studies have tended to report rates of 0.5%/year or lower. Despite these data and concerns, at least two actuaria l studies have suggested that the risk of death in patients with BE does no t differ from that of a control population. This review of the literature f ocuses on the epidemiology of BE and the associated incidence of its sequel ae. Copyright (C) 2001 S.Karger AG, Basel