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The columnar-lined (Barrett's) oesophagus in black patients
1Department of Surgery, University of the Witwatersrand, Johannesburg.
Objective:
To determine the prevalence of a columnar-lined Barrett's oesophagus in black patients.
Design:
In the present study we retrospectively reviewed the records of all black patients with Barrett's oesophagus.
Setting:
Johannesburg Hospital's referral-based oesophageal clinic.
Subjects:
Eleven black patients with Barrett's oesophagus from a series of 216 consecutive patients with Barrett's oesophagus who were referred to the oesophageal clinic from 1970 to 1993.
Main Outcome Measures:
Prevalence, demographics and characteristics of black patients with a columnar-lined Barrett's oesophagus.
Results:
Only 5% of the total series of Barrett's patients were black. Because the ratio of black to white in Johannesburg is about 5:1, the comparative prevalence of Barrett's oesophagus in blacks is extremely low when compared with that of whites. Although the number of patients is small, this series demonstrates that a columnar-lined oesophagus does occur in blacks. When compared with Caucasians, blacks had far fewer associated hiatus hernias (33%). The presentation of blacks is also different in that a greater proportion presented with adenocarcinoma (36%).
Conclusions:
Gastro-oesophageal reflux and related conditions such as a columnar-lined oesophagus are uncommon conditions in African blacks. This series demonstrates however that a columnar-lined oesophagus does occur in black patients. It is possible that in black patients an inherent defect of the lower oesophageal sphincter rather than a hiatus hernias is the cause of the reflux. A greater proportion of this small group of patients presented with adenocarcinoma than would have been expected. The reasons for the low prevalence of Barrett's oesophagus in black South Africans are unknown.