Prevalence of Barrett's esophagus in an urban Korean population: a multicenter study

It had been believed that over 75% of cases of esophageal carcinoma were squamous cell carcinoma (SCC). However, recently, in Western countries, the incidence of SCC has decreased, while the rate of adenocarcinoma has increased dramatically, accounting for almost 50% of esophageal carcinomas. With this change, concern over Barrett's esophagus (BE) has increased. Traditionally, it was believed that BE affected Asians less frequently. However, accelerated westernization has changed the lifestyle of Asians dramatically, and this raises the question that the prevalence might be changed in Asians living in Asia. Lacking reports on the prevalence of BE in the Korean population, we examined the data from endoscopic examinations performed at five referral hospitals in Seoul, Korea, to estimate the period prevalence of BE.

One thousand five hundred and fifty-three patients who presented themselves to five referral hospitals due to various gastrointestinal symptoms prospectively underwent upper gastrointestinal endoscopic examinations and were enrolled in the study. Two biopsy specimens were taken from any parts of pink mucosa 3 cm or more above the squamocolumnar junction.

BE was detected in 5 of the 1553 patients who underwent upper gastrointestinal endoscopic examinations, and the approximate period prevalence of BE in Korean patients in the five referral hospitals was 3.2 per 1000. Of the 5 patients, two were men and three women with a mean age of 65 +/- 11.8 (mean +/- SD) years. All these patients had a body mass index (BMI) of less than 25 and were not obese. Regurgitation was described by 2 (40%) patients with BE, and heartburn was complained of by 4 (80%) patients. Of the 5 patients with BE, 3 (60%) patients had esophagitis, 2 (40%) patients had hiatal hernia, and none of the patients had Helicobacter pylori infection. The gross type of BE consisted of type I (spike) in 2 (40%) patients, type II (circumferential type II) in 1 (20%) patient, type III (circumferential type III) in 1 (20%) patient, and mixed type in 1 (20%) patient. Specialized intestinal metaplasia was found in all 5 patients.

The period prevalence of BE among the patients of five referral hospitals was 3.2 per 1000, and it seems that the prevalence of BE in Korean urban area is lower than that in Western countries.