Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma

Abstract

Barrett’s esophagus (BE) is a common condition, and is the precursor to esophageal adenocarcinoma, a disease with increasing burden in the western world, especially in Caucasian males. The incidence of BE increased dramatically during the late-20th century and incidence estimates continue to increase, with a prominent male:female ratio. The prevalence is between 0.5 – 2.0 percent. A number of anthropomorphic and behavioral risk factors exist for BE including obesity and tobacco smoking, but GERD is the strongest risk factor, and the risk is more pronounced with long-standing GERD. Esophageal adenocarcinoma (EAC) is the most common form of esophageal cancer in the U.S. Risk factors include GERD, tobacco smoking, and obesity, while NSAIDs and statins may be protective. A major factor predicting progression from non-dysplastic BE to EAC is the presence of dysplastic changes seen on esophageal histology, although a number of issues limit the utility of dysplasia as a marker for disease. Length of the involved BE segment is another risk for progression to high-grade dysplasia and cancer. Biomarkers have shown promise, but none are approved for clinical use.

Epidemiology of Barrett’s esophagus and esophageal adenocarcinoma in Spain. A unicentric study

“…In the last years, different studies have reported a decrease in most of the prevalent types of cancer, yet other types such as pancreatic, liver, thyroid, kidney and esophageal adenocarcinoma have increased, with up to a six-fold increase in the latter (24)(25)(26).…”

Association between coffee or tea drinking and Barrett’s esophagus or esophagitis: an Italian study

“…In Western areas, the prevalence of BE is estimated to be between 0.5 and 6.8%, to arrive at 15% in symptomatic patients. 1 In Italy it has been estimated to be around 1.5%. 2,3 Chronic gastroesophageal reflux disease (GERD), a spectrum of hiatal hernia, gastroesophageal reflux, heartburn and regurgitation is a risk factor for both BE and erosive esophagitis (E).…”

“…It is worth noting that GERD is not always present in all patients with endoscopic diagnosis of BE or E and they may also share other modifiable risk factors such as smoking and overweight. 1,4,5 So far, epidemiologic data regarding coffee and tea consumption and risk of BE and E in Western areas are scarce and inconclusive. Only a few papers examined the relationship between coffee or tea intake and BE or E, while more data exist on the association with some types of cancer.…”

Barrett’s esophagus: best practices for treatment and post-treatment surveillance

“…The prevalence of BE in patients undergoing endoscopy for any indication has been estimated to be at 1-2%, and this increases to 5-15% in patients that have GERD symptoms (3). Risk factors for BE include older age, male sex, Caucasian race, GERD symptoms (especially starting at a young age), central abdominal obesity, and possibly tobacco smoking (4).…”

“…Studies have estimated that patients with BE have a significantly increased risk (30-to 125-fold) of developing EAC compared to patients without BE (4). However, the absolute risk of EAC in patients with nondysplastic BE is low, at 0.1-0.5% per year, with most recent studies suggesting the incidence is on the lower end of that range (5)(6)(7).…”