Effect of gastro‐esophageal reflux symptoms on the risk of Barrett's esophagus: A systematic review and meta‐analysis

Abstract

Background and Aim Gastro‐esophageal reflux (GER) is the main predisposing factor for Barrett's esophagus (BE). A more precise estimate of the association of GER symptoms with the risk of BE would be important to prioritize endoscopic screening. We conducted a systematic review and meta‐analysis to examine this issue. Methods MEDLINE, EMBASE, and EMBASE Classic were searched to identify cross‐sectional studies that reported the prevalence of BE based on presence of GER symptoms. The prevalence of BE was compared according to presence or absence of GER symptoms using an odds ratio (OR), with a 95% confidence interval (CI). Specificity and sensitivity of GER symptoms for predicting BE was calculated. Results Of 10,463 citations evaluated, 19 studies reported the prevalence of BE in 43,017 subjects. The pooled OR among individuals with weekly GER symptoms compared with those without was 1.67 (95% CI 1.30–2.15) for endoscopically suspected BE, and 2.42 (95% CI 1.59–3.68) for histologically confirmed BE. No significant association was found between weekly GER symptoms and the presence of short segment BE (OR 1.30; 95% CI 0.86–1.97), whereas a strong association was present with long segment BE, with an OR of 6.30 (95% CI 2.26–17.61). Conclusions Gastro‐esophageal reflux symptoms are associated with an increased odds of BE, with a further increase when weekly symptoms are present. Overall, GER symptoms showed low sensitivity and specificity for predicting BE; however, a strong association was found between weekly GER symptoms and long segment BE, but not short segment BE, suggesting that it may be worth considering screening individuals with weekly GER symptoms to rule out long segment BE.

Genetic evidence causally linking gastroesophageal reflux disease to cholecystitis：A two- sample Mendelian randomization study

“…The relationship between GERD and chronic cholecystitis is intricate, involving complex mechanisms. Research has demonstrated that patients with esophagitis and Barrett's esophagus exhibit substantially elevated levels of bile acids compared to control groups, which are linked to acid re ux (31,32), and bile re ux-induced chemical damage has been identi ed as a signi cant contributor to esophageal mucosal rupture and refractory GERD in patients. Abnormal gallbladder function and anatomical structure are known to be contributing factors to cholestasis, which can result in impaired gallbladder function in terms of bile concentration and biliary pressure regulation.…”

Distance to Health Care Facilities, Lifestyle Risk Factors, and Stage at Diagnosis in relation to Geographic Pattern of Esophageal Cancer in Tanzania, 2006–2016

“…Therefore, early EC cases could be missed for various reasons. Diagnosis of EC is difficult as systems could be nonspecific Gastrointestinal reflux Disease-(GERD-) like symptoms [27]. First, remote areas of Tanzania may not be served by a regional hospital that can provide diagnostic laboratory services and radiology, compared to ORCI, which provides these services and can aid in detecting EC [28][29][30].…”

Management of gastro-esophageal reflux disease: Practice-oriented answers to clinical questions

“…Endoscopy is also recommended in all patients with GERD symptoms and at least 2 of the following risks factors for Barrett’s esophagus: Age ≥ 50 years, male gender, Caucasian ethnicity, obesity, family history for Barrett’s esophagus or esophageal adenocarcinoma, and smoking[ 2 , 5 ]. Indeed, the prevalence of Barrett’s esophagus among patients with GERD symptoms is only about 5%-7%[ 6 , 7 ], therefore endoscopy should be reserved to patients with multiple risk factors for this condition.…”