Prevalence of Barrett's esophagus in asymptomatic individuals

Gerson, Lauren B.; Shetler, Katerina; Triadafilopoulos, George

doi:10.1053/gast.2002.34748

Cited by 403 publications

(278 citation statements)

References 20 publications

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“…Only 5-15% of subjects with chronic (>5 years) and frequent (weekly or more frequent) refl ux have BE ( 83 ), and as many as 50% of subjects with BE or EAC do not report chronic refl ux symptoms ( 31,84 ). Several studies have reported a substantial prevalence of BE in those without refl ux symptoms ( 27,85,86 ). Indeed, although refl ux symptoms are associated with long-segment BE, they may not be consistently associated with short-segment BE ( 31 ).…”

Section: Recommendationsmentioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,336

1,412

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Recent population studies suggest that gastroesophageal refl ux disease (GERD) is increasing in prevalence, both in the United States and worldwide ( 1,2 ). Th e diagnosis of GERD is associated with a 10-15% risk of Barrett's esophagus (BE), a change of the normal squamous epithelium of the distal esophagus to a columnar-lined intestinal metaplasia (IM). Risk factors associated with the development of BE include long-standing GERD, male gender, central obesity ( 3 ), and age over 50 years ( 4,5 ). Th e goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma (EAC), a malignancy that has been increasing in incidence since the 1970s ( 6,7 ).Th e purpose of this guideline is to review the defi nition and epidemiology of BE, available screening modalities for BE detection, rationale and methods for surveillance, and available treatment modalities including medical, endoscopic, and surgical techniques. In order to evaluate the level of evidence and strength of recommendations, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system ( 8 ). Th e level of evidence ranged from "high" (implying that further research was unlikely to change the authors' confi dence in the estimate of the eff ect) to "moderate" (further research would be likely to have an impact on the confi dence in the estimate of eff ect) to "low" (further research would be expected to have an important impact on the confi dence in the estimate of the eff ect and would be likely to change the estimate) or "very low" (any estimate of eff ect is very uncertain). Th e strength of a recommendation was graded as "strong" when the desirable eff ects of an intervention clearly outweighed the undesirable eff ects and as "conditional" when there was uncertainty about the tradeoff s. We used meta-analyses or systematic reviews when available, followed by clinical trials and cohort and case-control studies. In order to determine the level Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with refl ux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-defi nition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is ...

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Section: Recommendationsmentioning

confidence: 99%

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,336

1,412

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“…On the other hand, this is also possible that the pathogenic mechanisms for the two entities (i.e., EE and BE), are different, but are often seen together due to shared patient characteristics and risk factors. Interestingly though, BE has also been identified in up to 25% of asymptomatic or minimally symptomatic individuals [11] . In a multi-center study of non-veteran patients (60% men, 78% Caucasians) presenting for colonoscopy, the prevalence of BE was 6.8% in those with or without the symptoms of heartburn, and rose up to 15% if they had EE on the endoscopy [12] .…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Barrett’s esophagus in patients with moderate to severe erosive esophagitis

Gilani¹,

Gerkin²,

Ramirez³

et al. 2008

WJG

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AIM:To investigate the proportion of patients with moderate-severe erosive esophagitis (EE) who will have Barrett's esophagus (BE) after healing of inflammation. METHODS: Patients with EE of Los Angeles (LA) class B, C and D who underwent follow-up endoscopy documenting complete mucosal healing. RESULTS: A total of 86/169 patients were suspected of having BE (38 before healing and 48 after healing of EE) and, 46/86 eventually had the histological confirmation. At index esophago-gastro-duodenoscopy (EGD), BE was suspected in 38/169 (22%), and ultimately, histologically confirmed in 20 of these. In 11 patients where biopsies were performed in the presence of inflammation, BE was detected in 2 and missed in 5 (including 2 dysplasias). In 131/169 patients (77.5%), BE was not suspected at index EGD. After healing of EE though, 48 patients had suspicion of BE who underwent biopsies, and in 26 of these histology was positive for BE. The length of inflammation had a linear correlation with the length of BE (P = 0.01). Out of multiple variables to predict BE, only the suspicion at index endoscopy was statistically significant (P = 0.01). CONCLUSION: B E wa s s e e n i n 4 6 / 1 6 9 ( 2 7 % ) patients with EE of LA class B, C and D. The length of EE can predict the length of underlying BE segment.Even when suspected, BE and associated dysplasia can be missed in the presence of inflammation; therefore, repeat evaluation should be considered after complete healing of esophagitis.

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“…Four similar studies were performed in the USA, Sweden, and Italy (33)(34)(35)(36). In the USA, the studies on BE and ERD were performed with patients that applied for colonoscopy for colorectal carcinoma screening.…”

Section: The Epidemiology Of Gerd Complications In Turkey and Around mentioning

confidence: 99%

How is the gastroesophageal reflux disease prevalence, incidence, and frequency of complications (stricture/esophagitis/Barrett’s esophagus/ carcinoma) in Turkey compared to other geographical regions globally?

Bor

Yüksel

2017

Turk J Gastroenterol

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Although many studies are conducted on gastroesophageal reflux disease (GERD) and its complications, the questionnaires and reflux definitions used in the studies are different. Mayo, GERD-Q, DIGEST-Q, RDQ, and various other questionnaires that were created and have been used in the studies. The GERD definition that is mostly accepted around the world is the presence of the complaints of heartburn and/or regurgitation at least once a week. However, many different definitions, such as the presence of heartburn and/or regurgitation at least twice a week or at least once a year (if once a week, "frequent"; if once a year, "rare") and the presence of heartburn and/or regurgitation without considering the frequency and severity, were all used in the studies. Therefore, it is quite difficult to obtain a single datum by collecting these studies. However, studies including all questionnaires and reflux definitions were considered while collecting this data.Another problem encountered while performing epidemiological scanning of GERD is that when the world was separated into two parts as the East and the West, some countries that were different from each other were included in the same group (such as Iran-China and Germany-Brazil). Even though continents are considered for this separation, countries that do not resemble each other from any perspective, such as Iran and China, were included in the same group. Therefore, groups must be formed according to the higher number of ethnic distributions. There are also regional epidemiological differences even in the same country. Moreover, there is no term equivalent to heartburn and regurgitation in some Eastern languages.Turkey is geographically located in the middle of the Eastern and Western countries and the epidemiology of GERD and its complications is similar to both geographical groups (Figure 1). In the Eastern countries, the prevalence of GERD is lower and regurgitation is predominant. On the other hand, in the Western countries, the prevalence of GERD is higher and heartburn is predominant. Considering the complications, erosive esophagitis, Barrett's esophagus, and associated esophageal adenocarcinoma are seen in the Western countries more commonly.In GERD epidemiological studies performed in Turkey, the Mayo questionnaire was mostly used (1, 2). The GERD-Q form was used in one study (3). The studies in which the Mayo questionnaire was used, found the prevalence of GERD as 20% (1), 19.3% (2), 12.5% (4), and 22.8% (5,6), respectively. In the study using the other question form, the prevalence of GERD was 24.7% (3). When 5 studies were evaluated cumulatively, the prevalence was calculated to be 23%. It was observed that regurgitation was predominant in all of the studies. In the cumulative evaluation, the rate of prevalence was 23% for regurgitation and 19% for heartburn.While the date of the publications on the epidemiology of GERD goes back to the 2000s in the countries to the east of Turkey, the first articles on this subject were written in 1990s in the Western cou...

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Prevalence of Barrett's esophagus in asymptomatic individuals

Cited by 403 publications

References 20 publications

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus

Prevalence of Barrett’s esophagus in patients with moderate to severe erosive esophagitis

How is the gastroesophageal reflux disease prevalence, incidence, and frequency of complications (stricture/esophagitis/Barrett’s esophagus/ carcinoma) in Turkey compared to other geographical regions globally?

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