Global prevalence of Barrett’s oesophagus and oesophageal cancer in individuals with gastro-oesophageal reflux: a systematic review and meta-analysis

Abstract

ObjectivesChronic gastro-oesophageal reflux might lead to the development of Barrett’s oesophagus (BO) or even oesophageal adenocarcinoma. There has been no definitive systematic review and meta-analysis of data to estimate global prevalence of BO or oesophageal adenocarcinoma in individuals with gastro-oesophageal reflux.DesignWe searched MEDLINE, Embase and Embase Classic to identify cross-sectional surveys that reported prevalence of BO or oesophageal adenocarcinoma in adults with gastro-oesophageal reflux. We extracted prevalence for all studies, both for endoscopically suspected and histologically confirmed cases. We calculated pooled prevalence according to study location, symptom frequency and sex, as well as ORs with 95% CIs.ResultsOf the 4963 citations evaluated, 44 reported prevalence of endoscopically suspected and/or histologically confirmed BO. Prevalence of BO among individuals with gastro-oesophageal reflux varied according to different geographical regions ranging from 3% to 14% for histologically confirmed BO with a pooled prevalence of 7.2% (95% CI 5.4% to 9.3%), whereas pooled prevalence for endoscopically suspected BO was 12.0% (95% CI 5.5% to 20.3%). There was heterogeneity in many of our analyses. Prevalence of BO was significantly higher in men, both for endoscopically suspected (OR=2.1; 95% CI 1.6 to 2.8) and histologically confirmed BO (OR=2.3; 95% CI 1.7 to 3.2). Dysplasia was present in 13.9% (95% CI 8.9% to 19.8%) of cases of histologically confirmed BO, 80.7% of which was low-grade.ConclusionThe prevalence of Barrett’s oesophagus among individuals with gastro-oesophageal reflux varied strikingly among countries, broadly resembling the geographical distribution of gastro-oesophageal reflux itself. Prevalence of BO was significantly higher in men.

Systematic review with meta‐analysis: risk factors for Barrett's oesophagus in individuals with gastro‐oesophageal reflux symptoms

“…We assembled data from 13 cross‐sectional surveys that reported the prevalence of histologically confirmed BO at upper gastrointestinal endoscopy in individuals with gastro‐oesophageal reflux symptoms, according to several proposed risk factors. Although prevalence varied according to geographical location of the population under study, the overall prevalence of histologically confirmed Barrett's oesophagus in individuals with gastro‐oesophageal reflux symptoms was 7.0%, in line with our previous data 4 . The odds of Barrett's oesophagus were almost threefold higher in people with hiatal hernia, compared with those without, suggesting that the presence of hiatal hernia might contribute to the development of Barrett's oesophagus via increased oesophageal exposure to gastric contents.…”

“…Indeed, the presence of gastro‐oesophageal reflux is one of the most frequent indications for endoscopic examination of the upper gastrointestinal tract, primarily to exclude the presence of associated lesions, such as erosive esophagitis or Barrett's oesophagus. However, only 3% to 14% of individuals who undergo endoscopy due to gastro‐oesophageal reflux symptoms are found to have histologically confirmed Barrett's oesophagus, with a significantly higher prevalence in men 4 …”

Increased epithelial permeability syndrome in organic diseases of the upper gastrointestinal tract: systematization of literature data

“…), обобщившему результаты более 100 исследований, общемировая распространенность ГЭРБ составляет 13,98% (95% доверительный интервал -ДИ 12,47-15,56%) [15]. ГЭРБ является доказанным фактором риска пищевода Баррета (предраковое состояние) и аденокарциномы пищевода [16,17]. Недавний метаанализ L. Eusebi и соавт.…”

“…(2021 г. ), обобщивший результаты 44 исследований, показал, что частота выявления гистологически верифицированного пищевода Баррета у пациентов с ГЭРБ составляет 7,2% (95% ДИ 5,4-9,3) [17]. Более ранний метаанализ J. Rubenstein и соавт.…”

Efficacy of esophagoprotection with short periods of withdrawal of maintenance therapy with proton pump inhibitors in patients with Barrett's esophagus

“…(2021 г. ), обобщившему результаты 44 исследований, частота гистологически верифицированного ПБ у пациентов с ГЭРБ составляет 7,2% (95% ДИ 5,4-9,3%), тогда как эндоскопические признаки ПБ выявляются у 12,0% больных (95% ДИ 5,5-20,3%) [6]. Доказанными факторами риска ПБ являются европеоидная раса, мужской пол, табакокурение, абдоминальное ожирение [7][8][9][10].…”