Racial and Ethnic Disparities in the Prevalence of Barrett’s Esophagus Among Patients Who Undergo Upper Endoscopy

Abrams, Julian A.; Fields, Sydney; Lightdale, Charles J.; Neugut, Alfred I.

doi:10.1016/j.cgh.2007.10.006

Cited by 112 publications

(108 citation statements)

References 20 publications

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“…The incidence of Barrett's oesophagus, meanwhile, seems to have been stable in the United States (Cameron et al, 1990;Macdonald et al, 1997;Conio et al, 2001;Corley et al, 2009), which is in marked contrast to ADC (Figure 1). It has been reported that the proportion presenting with reflux as an indication for endoscopy is highest in Whites, followed by Hispanics and then Blacks (Abrams et al, 2008), which is parallel to the incidence order of Barrett's oesophagus and ADC. In addition, evidence suggests that although Whites, Blacks, and Asians report a similar prevalence of heartburn, Whites are more likely to suffer from erosive reflux disease (Spechler et al, 2002;El-Serag et al, 2004;Corley et al, 2007).…”

Section: Discussionmentioning

confidence: 81%

Oesophageal cancer incidence in the United States by race, sex, and histologic type, 1977–2005

2009

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BACKGROUND: In the United States, the rates and temporal trends of oesophageal cancer overall and for the two predominant histologic types -adenocarcinoma (ADC) and squamous cell carcinoma (SCC) -differ between Blacks and Whites, but little is known with regard to the patterns among Asians/Pacific Islanders or Hispanics. METHODS: Using the Surveillance, Epidemiology, and End Results programme data, we analysed oesophageal cancer incidence patterns by race, sex, and histologic type for the period 1977 -2005. RESULTS: Total oesophageal cancer incidence has been increasing among Whites only; the rates among all other race groups have declined. Moreover, rates among White men surpassed those among Blacks in 2004. Oesophageal SCC rates have been decreasing among virtually all racial/ethnic groups; rates among Hispanic and Asian/Pacific Islander men have been intermediate to those of Blacks and Whites, with rates among women being lower than those among Blacks or Whites. The ADC rates among Hispanic men may be rising, akin to the historical trends among Whites and Blacks. The sex ratios for these cancers also varied markedly. CONCLUSIONS: These observations may provide clues for aetiological research.

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Section: Discussionmentioning

confidence: 81%

Oesophageal cancer incidence in the United States by race, sex, and histologic type, 1977–2005

2009

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“…Although the evidence for lower prevalence of BE in African Americans compared with Caucasians is consistent ( 48,49 ), the results of studies comparing BE incidence in Hispanics and nonHispanic whites are inconsistent, likely refl ecting the heterogeneity of the Hispanic population ( 49,50 ).…”

Section: Summary Of Evidencementioning

confidence: 99%

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

Shaheen

Falk

Iyer

et al. 2016

American Journal of Gastroenterology

1,323

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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“…Understanding the interactions in the BE pathogenesis between H. pylori, host, racial disparity and environmental factors may be absolutely difficult, because synergistic effects among these factors including H. pylori virulence need to be taken into account. [60][61][62] Further studies on the genetic and epigenetic alterations of H. pylori-related BE are awaited in not only Asian populations with a high rate of H. pylori infection but also in Western countries.…”

Section: Discussionmentioning

confidence: 99%

Effects of Helicobacter pylori infection on genetic instability, the aberrant CpG island methylation status and the cellular phenotype in Barrett's esophagus in a Japanese population

Moriichi

Watari

Das³

et al. 2008

Intl Journal of Cancer

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Genetic or epigenetic alterations in Barrett's esophagus (BE) with/without Helicobacter pylori (H. pylori) infection remain unclear. We examined the effects of H. pylori infection on genetic instability (GIN), the CpG island methylation status and a biomarker related to BE carcinogenesis. We analyzed 113 Japanese individuals with endoscopically suspected BE. The patients included, Group CLE (n 5 25): no specialized intestinal metaplasia (SIM) in a columnar lined epithelium (control); Group BE (n 5 88): all had SIM. Microsatellite instability and a loss of heterozygosity as GIN, the methylation status at hMLH1, E-cadherin, p16 and APC, and immunoreactivity using a monoclonal antibody (mAb) Das-1, which specifically reacts with BE, were evaluated. Nine additional patients with BE were prospectively followed up for 2 years after successful H. pylori eradication. The frequency of GIN, methylation at E-cadherin and APC, and mAb Das-1 reactivity in Group BE was significantly higher than that in Group CLE (p < 0.0001, p < 0.0001 and p < 0.005, and p < 0.0001, respectively). Furthermore, GIN, E-cadherin methylation and mAb Das-1 reactivity showed a significantly higher incidence in patients with H. pylori infection than in those without H. pylori infection (p < 0.01, p < 0.005, and p < 0.01, respectively). Interestingly, the patients from Group BE were observed to change to a stable state of molecular alterations in 60% for GIN, 42.9% for E-cadherin methylation and 55.6% for APC methylation, or a reduction of mAb Das-1 reactivity was noted in 25% following eradication. H. pylori infection may therefore affect these molecular alterations associated with the pathogenesis of BE, to some degree, in the Japanese population. '

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Racial and Ethnic Disparities in the Prevalence of Barrett’s Esophagus Among Patients Who Undergo Upper Endoscopy

Cited by 112 publications

References 20 publications

Oesophageal cancer incidence in the United States by race, sex, and histologic type, 1977–2005

Oesophageal cancer incidence in the United States by race, sex, and histologic type, 1977–2005

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

Effects of Helicobacter pylori infection on genetic instability, the aberrant CpG island methylation status and the cellular phenotype in Barrett's esophagus in a Japanese population

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