Barrett's esophagus: Epidemiology, clinical manifestations, and diagnosis
- Stuart J Spechler, MD
Stuart J Spechler, MD
- Chief, Division of Gastroenterology
- Co-Director, Center for Esophageal Diseases
- Baylor University Medical Center at Dallas
- Co-Director, Center for Esophageal Research
- Baylor Scott and White Research Institute
Barrett's esophagus is the condition in which any extent of metaplastic columnar epithelium that predisposes to cancer development replaces the stratified squamous epithelium that normally lines the distal esophagus. The condition develops as a consequence of chronic gastroesophageal reflux disease (GERD), and predisposes to the development of adenocarcinoma of the esophagus.
The issues related to the clinical manifestations and diagnosis of Barrett's esophagus will be reviewed here. The pathogenesis, malignant transformation, and management of this disorder, including surveillance for adenocarcinoma, are discussed separately. (See "Barrett's esophagus: Pathogenesis and malignant transformation" and "Barrett's esophagus: Surveillance and management".)
Barrett's esophagus is usually discovered during endoscopic examinations of middle-aged and older adults whose mean age at the time of diagnosis is approximately 55 years . Although Barrett's esophagus can affect children, it rarely occurs before the age of five . This observation supports the contention that Barrett's esophagus is an acquired condition, not a congenital one.
Estimates of the prevalence of Barrett's esophagus in the general population have varied widely ranging from 0.4 to more than 20 percent depending in part upon the population studied and the definitions used [3-7]. The male to female ratio is approximately 2:1 . The following studies illustrate the range of findings:
●A study from Sweden estimated that Barrett's esophagus was present in 1.6 percent of the general population . Applying these prevalence estimates to the United States would translate into about 3.3 million individuals with Barrett's esophagus .
An important additional observation from this report was that 44 percent of patients lacked "troublesome heartburn and/or acid regurgitation during the past three months" suggesting that screening programs based upon reflux symptoms alone may be inadequate to identify patients with Barrett's esophagus.
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- CLINICAL FEATURES
- CANCER INCIDENCE
- DIAGNOSTIC CRITERIA
- Intestinal metaplasia at the GEJ and in the gastric cardia
- Differences between long- and short-segment Barrett's
- Dysplasia and adenocarcinoma in short-segment Barrett's
- SCREENING PATIENTS FOR BARRETT'S ESOPHAGUS
- - American Gastroenterological Association
- - American College of Gastroenterology
- - American College of Physicians
- Alternate screening methods
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS