Prevalence of Barrett's esophagus in Japan

Abstract

Norman Barrett originally described two special conditions, namely, a congenital short esophagus with an intrathoracic gastric columnar lining and congenital gastric heterotropia in the esophagus with ulceration. Thereafter, these conditions began to be known as "Barrett's esophagus." It is an acquired condition of esophageal columnar metaplasia following chronic gastroesophageal refl ux, and the classical Barrett's esophagus has been defi ned as having a circumferential columnar metaplasia spreading minimally 3 cm or more upward from the esophagogastric junction, because the esophagogastric junction still tends to be difficult to recognize precisely. Recently, from the point of view of adenocarcinogenesis of the esophagus, the term and concept of short-segment Barrett's esophagus (SSBE) as a developing condition of the classical Barrett's esophagus and the confi rmation of intestinal metaplasia has been required; however, the defi nition of Barrett's esophagus still remains controversial. In Japan, although the prevalence of shortsegment Barrett's esophagus has been reported to vary considerably, from 1% to 52%, the prevalence of long-segment Barrett's esophagus (LSBE) tends to range from 0% to 2%, which is a quite lower rate than that observed in Western countries. The great difference in the prevalence of SSBE is caused by the differences in the criteria of the esophagogastric junction and the defi nition concerning the necessity of intestinal metaplasia. A universally accepted defi nition of Barrett's esophagus is thus needed to accurately determine its actual prevalence.

Differences in the endoscopic detection rates of Barrett’s esophagus using the Japanese and Western criteria: a pilot study

“…Sharma et al reported that endoscopists were not able to reliably measure short segments of BE (<1 cm) using the P-criteria (the kappa value was 0.21) [11]. In contrast, the J-criteria can more readily identify endoscopic BE segments of less than 10 mm, and it may also be able to identify ultra-short segments of BE more consistently [7]. Although the difference in the detection rate of BE of less than 10 mm between the J-criteria and the P-criteria was not significant, it tended to be higher using the J-criteria.…”

“…In Western countries, the prevalence of endoscopically suspected BE was reported to be approximately 10 % [6]. In a recent multicenter prospective Japanese study, the prevalence of endoscopically suspected BE was reported to be 24.1 %, of which 99.2 % were SSBE [7]. That was considerably higher than in Western countries.…”

Multiple lesions of adenocarcinoma with extensive dysplasia in long-segment Barrett’s esophagus treated with thoracoscopic surgery: a case report

“…The difference in the prevalence of SSBE seems to be caused by the difference in the defi nition of the esophagogastric junction (EGJ) and whether intestinal metaplasia is included. Kawano reviewed the prevalence of BE worldwide in detail and emphasized that the actual prevalence should be determined by a universally acceptable defi nition of BE because different defi nitions of BE have resulted in varying prevalence rates [2]. According to the American College of Gastroenterology guidelines [3], the variation of BE prevalence in Japan may be underrepresented.…”

“…According to the American College of Gastroenterology guidelines [3], the variation of BE prevalence in Japan may be underrepresented. On the other hand, the prevalence of classical BEs (long-segment Barrett's esophagus, LSBE) is relatively constant, with a range of 0.3%-0.6% in adults undergoing EGD in Japan [2].…”

“…In the Japanese literature, the prevalence of SSBE in adults undergoing esophagogastroduodenoscopy (EGD) has been reported to vary considerably, ranging from 1% to 52% [2]. The difference in the prevalence of SSBE seems to be caused by the difference in the defi nition of the esophagogastric junction (EGJ) and whether intestinal metaplasia is included.…”