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Systematic review and meta-analysis of prevalence and risk factors for Barrett’s esophagus

      Background and Aims

      Although screening for Barrett’s esophagus (BE) is recommended in individuals with multiple risk factors, the type and number of risk factors necessary to trigger screening is unclear. In this systematic review and meta-analysis, we aimed to assess the relationship between number of risk factors and prevalence of BE.

      Methods

      Through October 17, 2018 we searched studies that described the prevalence of BE in the general population and based on presence of risk factors that included GERD, male gender, age >50 years, family history of BE and esophageal adenocarcinoma, and obesity (defined as body mass index >35). Risk of BE based on number of risk factors was assessed using meta-regression while controlling for potential confounders.

      Results

      Of 2741 studies, 49 were included in the analysis (307,273 individuals, 1948 with biopsy specimen–proven BE). Indications varied by study. The prevalence of BE for various populations was as follows: low-risk general population, .8% (95% confidence interval [CI], .6%-1.1%); GERD, 3% (95% CI, 2.3%-4%); GERD plus presence of any other risk factor, 12.2% (95% CI, 10.2%-14.6%); family history, 23.4% (95% CI, 13.7% -37.2%); age >50, 6.1% (95% CI, 4.6%-8.1%); obesity, 1.9% (95% CI, 1.2%-3%); and male sex, 6.8% (95% CI, 5.3%-8.6%). Prevalence of BE varied significantly between Western and non-Western populations. In a meta-regression, controlling for the region of the study, age, and gender, there was a positive linear relationship between the number of risk factors and the prevalence of BE.

      Conclusions

      Results of this study provide estimates of BE prevalence based on the presence and the number of risk factors. These results add credence to current guidelines that suggest screening in the presence of multiple risk factors.

      Abbreviations:

      BE (Barrett’s esophagus), CI (confidence interval), EAC (esophageal adenocarcinoma)
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      Linked Article

      • Risk assessment for Barrett’s esophagus: so near, yet so far!
        Gastrointestinal EndoscopyVol. 90Issue 5
        • Preview
          Norman Barrett first described Barrett’s esophagus (BE) as salmon-colored mucosa lining the distal esophagus, but little did he know that this entity would be a topic of great curiosity and research in gastroenterology for its definition, for its diagnosis, and especially for its role as a premalignant condition for esophageal adenocarcinoma (EAC).1 Over the years, the incidence of EAC has risen severalfold. Patients often present late, and by the time the diagnosis is established, the disease is advanced, with a poor prognosis.
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