Epidemiology and significance of Barrett's esophagus

Barrett's esophagus (BE) is of interest because of its recognized association with esophageal adenocarcinoma. While BE develops in a minority of patients with gastroesophageal reflux disease, its diagnosis has markedly increased over the last 30 years. Although a concurrent increase in the number of endoscopies performed annually has improved the ability to diagnose BE, the increase in prevalence appears to be a true finding. Conflicting data in the literature confound an accurate assessment of the risk for adenocarcinoma in patients with BE. Certain factors associated with BE also hold for esophageal adenocarcinoma: greater severity of reflux symptoms, specific pattern of symptoms (particularly nocturnal), longer duration of symptoms, white race, and male gender. One report has suggested a 45-fold increase in cancer risk for patients with frequent, severe and long-standing heartburn symptoms. New cases of esophageal adenocarcinoma are also increasing, especially in white males, with over 6,000 new cases diagnosed in 1995. BE can progress to esophageal dysplasia and adenocarcinoma; hence, early diagnosis and surveillance of BE and treatment of high-grade dysplasia leads to improved survival. The reported risk of developing cancer in BE ranges from 0.4 to 1.9%/year of follow-up. Most recent studies have tended to report rates of 0.5%/year or lower. Despite these data and concerns, at least two actuarial studies have suggested that the risk of death in patients with BE does not differ from that of a control population. This review of the literature focuses on the epidemiology of BE and the associated incidence of its sequelae.