Gastroenterology

Gastroenterology

Volume 129, Issue 6, December 2005, Pages 1825-1831
Gastroenterology

Clinical–alimentary tract
Prevalence of Barrett’s Esophagus in the General Population: An Endoscopic Study

https://doi.org/10.1053/j.gastro.2005.08.053Get rights and content

Background & Aims: Barrett’s esophagus (BE) is associated with esophageal adenocarcinoma, the incidence of which has been increasing dramatically. The prevalence of BE in the general population is uncertain because upper endoscopy is required for diagnosis. This study aimed to determine the prevalence of BE and possible associated risk factors in an adult Swedish population. Methods: A random sample (n = 3000) of the adult population (n = 21,610) in 2 municipalities was surveyed using a validated gastrointestinal symptom questionnaire (response rate, 74%); a random subsample (n = 1000; mean age, 53.5 years; 51% female) underwent upper endoscopy. Endoscopic signs suggestive of columnar-lined esophagus (CLE) were defined as mucosal tongues or an upward shift of the squamocolumnar junction. BE was diagnosed when specialized intestinal metaplasia was detected histologically in suspected CLE. Results: BE was present in 16 subjects (1.6%; 95% confidence interval, 0.8–2.4): 5 with a long segment and 11 with a short segment. Overall, 40% reported reflux symptoms and 15.5% showed esophagitis; 103 (10%) had suspected CLE, and 12 (1.2%) had a visible segment ≥2 cm. The prevalence of BE in those with reflux symptoms was 2.3% and in those without reflux symptoms was 1.2% (P = .18). In those with esophagitis, the prevalence was 2.6%; in those without, the prevalence was 1.4% (P = .32). Alcohol (P = .04) and smoking (P = .047) were independent risk factors for BE. Conclusions: BE was found in 1.6% of the general Swedish population. Alcohol and smoking were significant risk factors.

Section snippets

Setting

The setting consisted of 2 neighboring communities in northern Sweden, Kalix and Haparanda, with 18,408 and 10,580 inhabitants, respectively (as of December 1998). The age and sex distribution was similar to the national average in Sweden.19

This study was approved by the Umeå University Ethics Committee and conducted in accordance with the revised Declaration of Helsinki in 1998.

Sampling

By using the computerized national population register, covering all citizens in the 2 communities by date of birth

Endoscopy

Suspected CLE was found in 103 cases (10.3%; mean age, 55.7 years; 60.2% men). Twelve of them (1.2%) with a mean age of 59 years (7 men) had a long segment. Of the 87 suspected CLE cases without SIM in the biopsy specimens, there were 83 cases with columnar epithelium, 3 with squamous epithelium, and 1 with missing biopsy specimens. Hence, 96.1% of the suspected CLE had columnar epithelium in the biopsy specimens. On biopsy specimens from the distal esophagus and gastroesophageal junction, 60

Discussion

Within the framework of a population-based study using endoscopy, we have examined the prevalence of BE and associated risk factors. The cohort represents a random unselected adult population. We found that the prevalence of BE was 1.6% (LSBE, 0.5%; SSBE, 1.1%).

This prevalence of BE is in accordance with recently reported prevalence figures in large selected cohorts.15, 16 The prevalence of LSBE (0.5%) is also only modestly higher than that reported in the 1990 study by Cameron et al, in which

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    Supported in part by the Swedish Research Council, the Swedish Society of Medicine, Mag-tarm sjukas förbund, Norrbotten County Council (Sweden), and AstraZeneca R&D (Sweden).

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