Endoscopic Prevalence of Barrett's Esophagus in a Predominantly African American and Hispanic Population

Background and aim Barrett's esophagus (BE) is a well-known premalignant disorder. Investigators have shown that the prevalence of histologically confirmed BE varies among ethnic groups in the US. However, these studies were not performed at institutions that predominantly serve US minority populations. The aim of this study was to assess the prevalence of histologically confirmed BE at an institution that serves a predominantly African American (AA) and Hispanic American patient population. Methods The Harlem Hospital endoscopy and pathology databases were searched to identify all patients who underwent esophagogastroduodenoscopy (EGD) with biopsy and had histologically confirmed BE. Histological confirmation of BE was determined by the presence of intestinal metaplasia and Alcian blue-stained goblet cells in biopsies obtained from salmon-colored esophageal mucosa. Demographic data collected included age, sex, race/ethnicity, BMI, history of gastroesophageal reflux disease, endoscopic BE length, presence of hiatal hernia, esophagitis, or esophageal ulcer, presence or absence of dysplasia, proton pump inhibitor use, active Helicobacter pylori infection, and smoking and alcohol use. Results A total of 3,012 patients underwent EGD during the study period. Esophageal biopsy was performed on salmon-colored esophageal mucosa suspicious for BE in 18 individuals. BE was histologically confirmed in eight patients: five AAs, two Hispanics, and one non-Hispanic White (nHW). The overall prevalence of BE was 0.2%, with a lower prevalence observed among AA patients (0.3%) and Hispanic patients (0.1%) than among nHW patients (3.3%, p < 0.05). Four patients had dysplasia (three with low-grade dysplasia and one with high-grade dysplasia; three AA and one Hispanic). Conclusions The prevalence of BE in our predominantly minority population was lower than that observed among nHW patients, consistent with previous literature. Investigations at the microbiome and genetic levels are needed to explain the observed disparity in BE prevalence among ethnic groups.