Utility of Endoscopy for Diagnosis of Barrett in a Non-Western Society: Endoscopic and Histopathologic Correlation

Abstract

Barrett esophagus is metaplastic transformation of esophageal squamous epithelium to columnar cells. A total of 1370 patients who had undergone upper endoscopy because of dyspeptic complaints were enrolled in the study. Age, sex, alcohol and smoking habits, body mass index, type and duration of symptoms (heartburn, epigastric pain, nausea, vomiting), and use of proton pump inhibitors were evaluated in all patients and recorded on standardized forms. Patients were grouped as normal esophagogastric junction, long-segment Barrett esophagus, and short-segment Barrett. Biopsies were taken from at least 6 points and examined histopathologically. Of the 1370 patients involved in the study, 748 (54.6%) were female and 622 (45.4%) were male. Mean age was 47.2 6 15.30 years. Short-segment Barrett esophagus was detected in 16 patients, and long-segment Barrett was detected in 11 patients. Although Barrett esophagus was detected in 11 cases that were suspected to have Barrett during endoscopy, histopathology was negative in all cases that were not suspected to have Barrett. Barrett esophagus prevalence was significantly higher in people who used alcohol and tobacco and who had hiatal hernia. Although Barrett esophagus was detected in 40% of cases that were suspected to have Barrett during endoscopy, histopathology was negative in all cases that were not suspected to have Barrett. Barrett was detected in 40.7% of cases that were suspected to have Barrett during endoscopy; histopathology was negative in all cases that were not suspected to have Barrett. Senstivity of endoscopy is questionable in detection of short-segment Barrett.

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

“…There were 44 articles that fulfilled the eligibility criteria, [16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49 Figure 2). The lowest prevalence was 0.6% reported by two studies, both of which were conducted in Turkey, [41,58] and the highest prevalence was 29%, reported in a study from the US. [17] The pooled prevalence of histologically confirmed BO in individual countries is provided in Figure 2, and the pooled prevalence according to geographical study location is provided in Table 1.…”

“…, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59] of which two reported the prevalence of endoscopically suspected BO only,[44,54] 30 reported the prevalence of histologically confirmed BO only,[16,17,18,20,22,23,24,25,26,27,28,29,30,31,32,34,35,37,38,39,42,43,46,47,48,49,51,52,56,58] and 14 included studies[16,19,21,33,36,41,44,45,50,53,54,55,57,59] that reported the prevalence of endoscopic BO among subjects undergoing endoscopic examination for gastro-oesophageal reflux symptoms of any frequency contained 8,817 subjects and were geographically diverse, with three studies from Europe, two from North America, four from the Middle east...…”

“…There was statistically significant heterogeneity between studies in all of these analyses. -two studies reported the prevalence of histologically confirmed BO among subjects undergoing endoscopy due to gastro-oesophageal reflux symptoms of any frequency,[16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,45,46,47,48,49,50,51,52,53,55,56,57,58,59] containing a total of 26,521 subjects. The majority of studies were conducted in North America(13), Europe(8) or the Middle East(8).…”

Effect of gastro‐esophageal reflux symptoms on the risk of Barrett's esophagus: A systematic review and meta‐analysis

“…1). There were 19 articles that fulfilled the eligibility criteria, [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] of which two reported the prevalence of endoscopically suspected BE only, 27,33 13 reported the prevalence of histologically confirmed BE only, [18][19][20][21][22]24,25,[29][30][31][32]34,36 and four reported the prevalence of BE according to both definitions. 23,26,28,35 Agreement between investigators for assessment of study eligibility was excellent (kappa statistic = 0.92).…”

“…[18][19][20][21][22][23][24][25][26][28][29][30][31][32][34][35][36] Seven studies were conducted in Asia, 20,22,24,[30][31][32]36 four in Europe, 18,23,26,28 three in North America, 19,25,35 and three from the Middle East. 21,29,34 When data from all 17 studies were pooled, the prevalence of histologically confirmed BE in all individuals was 3.2% (95% CI 1.9% to 4.6%). Among subjects with GER symptoms the prevalence of histologically confirmed BE was 4.3% (95% CI 2.4% to 6.7%), compared with 2.4% (95% CI 1.4% to 3.7%) among those without.…”