Racial Disparity in the Sex Distribution, the Prevalence, and the Incidence of Dysplasia in Barrett’s Esophagus

Abstract

Goals Our aim was to study the prevalence of dysplasia and progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC) in African Americans (AA) with Barrett’s esophagus (BE) and compare to Non-Hispanic White (NHW) controls. Background BE, a precursor of EAC, is a disease of predominantly white men and is uncommon in AA. The prevalence of dysplasia and progression to HGD and EAC in AA with BE is not clearly known. Study All AA or NHW patients with confirmed BE i.e. specialized intestinal metaplasia seen between 2002 and 2013 at our institution were included. Variables such as age, gender, medication use, body mass index, date of endoscopy, hiatal hernia size, BE length, and histological findings were noted. Progression to HGD/EAC was evaluated. Results Fifty two AA and 2394 NHW patients with BE were identified. There was a higher percentage of women in AA cohort (46.2%) than NHW cohort (24.9% p< 0.001). Nondysplastic BE was more prevalent in AA than in NHW (80.8% vs. 68.4%, p= 0.058). In the surveillance cohort of 20 AA and 991 NHW, no racial differences in progression to HGD/EAC were observed during a median follow-up of 43 months. Conclusions This study includes the largest number of AA with histologically confirmed BE reported so far. 46.2 % of AA with BE in our study were women. There was a trend towards higher prevalence of nondysplastic BE in AA compared to NHW.

Racial Disparities in Adherence to Quality Indicators in Barrett's Esophagus: An Analysis Using the GIQuIC National Benchmarking Registry

“…The reasons for the different sex ratio observed among blacks and whites, such as differential effects of obesity and adipokines, differences in the genetic load of susceptibility alleles, referral bias and cultural differences in healthcare utilization, access, and adherence, also need to be explored in future studies. In addition, this study confirms many of the previously observed findings for black populations with BE (13,16,25–27). Blacks tend to demonstrate shorter segments of columnar-lined esophagus and are less likely to have confirmed BE with intestinal metaplasia on histology and BE-related dysplasia.…”

Exploring the Incidence and Associated Risk Factors of Barrett's Esophagus in African Americans: A Retrospective Study at Howard University Hospital

“…A study has shown that more than 50% of prevalent BE in populationbased communities is undiagnosed, hence, reducing the proportion of BE under surveillance [15,16]. Male sex, age over 50, smoking, White race, chronic reflux symptoms, central obesity, and family history are associated with BE [17][18][19][20][21]. It has been reported that the prevalence of BE in those without GERD symptoms was low (0.8%), however, a higher prevalence in those with known risk factors is observed in people with age over 50 years (6.1%), male sex (6.8%), obesity (1.9%), family history of BE/EAC (23%), and GERD (2.3%) [18,19,22,23].…”