Barrett's esophagus around the world: a systematic review and predictive modeling study

This study aimed to synthesize evidence on the prevalence of Barrett's esophagus (BE), estimate its global burden, and examine variation across studies.

Accurate BE prevalence estimates are essential for developing effective screening and surveillance strategies.

A systematic search was conducted in PubMed, Scopus, Web of Science, and EMBASE from inception to January 2026. Full-text articles and reference lists were also screened manually. Studies reporting BE prevalence in general or clinical populations were included. Extracted data covered study design, population characteristics, diagnostic criteria, biopsy protocols, geographic region, and publication period. Study-level analyses assessed methodological variability and temporal trends. Linear regression and generalized additive models were used to project BE prevalence through 2050.

Fifty-two studies, including approximately 8.4 million participants from 24 countries, were analyzed. The pooled mean prevalence of BE was 5.76%, with estimates ranging from 0.06% to 37.4%. Prevalence was higher in symptomatic endoscopy cohorts than in population-based cohorts (4.8% vs. 1.2%, p < 0.001). Studies requiring histologic confirmation of intestinal metaplasia reported lower estimates than those using broader definitions. Significant heterogeneity was observed by region and publication period. Seattle biopsy protocol reporting was documented in 38.5% of studies and improved after 2010. Forecast models projected BE prevalence of 12.8-13.2% by 2050 using linear modeling and 11.2-11.8% using GAM.

Reported BE prevalence varies widely, mainly due to differences in diagnostic criteria, study populations, and methodology. Standardized definitions, biopsy protocols, and reporting practices are needed to improve epidemiologic accuracy and guide screening.