The frequency of histologically confirmed Barrett’s esophagus varies by the combination of ethnicity and gender

Abstract

Background: Barrett's esophagus (BE) is the primary risk factor for esophageal adenocarcinoma (EAC). Limited data exists regarding the frequency of histologically confirmed BE by both gender and ethnicity in the United States. The study aim was to determine whether the frequency of histologically confirmed BE varies by ethnicity and gender. Methods: The University of Florida-Jacksonville endoscopy database was reviewed for all cases of salmon colored esophageal mucosa from September 2002 to August 2007. Histologic BE was diagnosed only if salmon colored esophageal mucosa was seen endoscopically and biopsy confirmed intestinal metaplasia with goblet cells. Data collected included: age at diagnosis, self-reported ethnicity [non-Hispanic white (nHw) or African American (AA)], gender, procedure indication, gastroesophageal reflux disease (GERD) history, atypical manifestations, cigarette smoking, alcohol use, proton pump inhibitor (PPI) use, BE endoscopic length, absence/presence of hiatal hernia, stricture or ulcer, and absence/presence/grade of dysplasia. Results: Salmon colored esophageal mucosa was identified in 391/7,308 patients, distributed ethnically as 306 nHw and 85 AA. Histologic BE was confirmed in 111/391 patients with ethnic distribution of: 95 nHw and 16 AA. Histologically confirmed BE frequency varied both by gender and ethnicity with nHw males having the highest (42.3%) and AA females the lowest (12.3%). Histologically confirmed BE frequency differed significantly between nHw males and nHw/AA females only (P<0.005). Conclusions: Histologically confirmed BE frequency varies by ethnicity and gender with nHw males having the highest frequency/risk and AA females the lowest. Investigation to improve understanding of the impact of race and gender in BE formation should be performed.

Sex, Racial and Ethnic Differences in Barrett’s Esophagus and Epidemiology of Esophageal Cancer

“…Of all the racial and ethnic groups, BE is most predominant in non-Hispanic whites. [9][10][11] In a retrospective crosssectional study of 2100 patients, the prevalence of BE was significantly higher in whites (6.1%) as compared to Hispanics (1.7%; P = .002) and blacks (1.6%; P = .004). On multivariable analysis, being Hispanic (OR: 0.38, CI: 0.18-0.84) or black (OR: 0.34, CI: 0.12-0.97) were independently associated with a decreased risk of BE.…”

“…11 These racial and ethnic disparities do not seem to be related to differences in exposure to risk factors for BE. 9,11 El-Serag et al, in a cross-sectional study that examined the association between race, GERD symptoms and endoscopic findings of erosive esophagitis, found no racial differences in the symptom severity of reflux (weekly heartburn and/or regurgitation: blacks-29%, whites-28%, other-25%; P = .80). Blacks, however, were less likely to have endoscopic findings of erosive esophagitis for the same frequency of GERD symptoms (adjusted odds ratio: 0.22-0.46; P < .001).…”

“…BE is 2 to 4 times more common in men than women. 2,9,14 In a recent meta-analysis of 28 136 patients with GERD, the pooled prevalence of histologically confirmed BE was 10.8% (95% CI: 6.6%-15.9%) in men and 4.8% (95% CI: 2.7%-7.5%) in women. 2 In another meta-analysis, the pooled male-to-female sex ratio for BE was 1.96 (95% CI: 1.77-2.17).…”

“…8 Numerous studies have highlighted sex, racial, and ethnic disparities in the incidence, prevalence and outcomes of BE and EAC. 7,[9][10][11][12][13] These disparities partly occur due to historic and contemporary social and economic inequalities. A better understanding of the cause and nature of these disparities could help guide meaningful action toward mitigating modifiable factors that drive these differences.…”

A Practical Approach to Screening and Surveillance of Barrett’s Esophagus

“…25,26 Established risk factors for BE include: chronic GERD, male sex, obesity (specifically central adiposity), family history of BE and/or EAC (specifically in a first-degree relative), tobacco history, and white race. 27-36 From these risk factors, societies have risk-stratified patients in which to consider screening for BE in practice. 10-14,26…”