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Barrett's esophagus: Epidemiology, clinical manifestations, and diagnosis

Stuart J Spechler, MD
Section Editor
Nicholas J Talley, MD, PhD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


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 [1]. Although Barrett's esophagus can affect children, it rarely occurs before the age of five [2]. 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 [8]. 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 [9]. Applying these prevalence estimates to the United States would translate into about 3.3 million individuals with Barrett's esophagus [10].

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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Literature review current through: Nov 2017. | This topic last updated: Jan 14, 2016.
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  1. Spechler SJ. Barrett's esophagus. Semin Gastrointest Dis 1996; 7:51.
  2. Hassall E. Columnar-lined esophagus in children. Gastroenterol Clin North Am 1997; 26:533.
  3. Hirota WK, Loughney TM, Lazas DJ, et al. Specialized intestinal metaplasia, dysplasia, and cancer of the esophagus and esophagogastric junction: prevalence and clinical data. Gastroenterology 1999; 116:277.
  4. Cameron AJ, Zinsmeister AR, Ballard DJ, Carney JA. Prevalence of columnar-lined (Barrett's) esophagus. Comparison of population-based clinical and autopsy findings. Gastroenterology 1990; 99:918.
  5. Ormsby AH, Kilgore SP, Goldblum JR, et al. The location and frequency of intestinal metaplasia at the esophagogastric junction in 223 consecutive autopsies: implications for patient treatment and preventive strategies in Barrett's esophagus. Mod Pathol 2000; 13:614.
  6. Gerson LB, Shetler K, Triadafilopoulos G. Prevalence of Barrett's esophagus in asymptomatic individuals. Gastroenterology 2002; 123:461.
  7. Ward EM, Wolfsen HC, Achem SR, et al. Barrett's esophagus is common in older men and women undergoing screening colonoscopy regardless of reflux symptoms. Am J Gastroenterol 2006; 101:12.
  8. Cook MB, Wild CP, Forman D. A systematic review and meta-analysis of the sex ratio for Barrett's esophagus, erosive reflux disease, and nonerosive reflux disease. Am J Epidemiol 2005; 162:1050.
  9. Ronkainen J, Aro P, Storskrubb T, et al. Prevalence of Barrett's esophagus in the general population: an endoscopic study. Gastroenterology 2005; 129:1825.
  10. Sampliner RE. A population prevalence of Barrett's esophagus--finally. Gastroenterology 2005; 129:2101.
  11. Rex DK, Cummings OW, Shaw M, et al. Screening for Barrett's esophagus in colonoscopy patients with and without heartburn. Gastroenterology 2003; 125:1670.
  12. Winters C Jr, Spurling TJ, Chobanian SJ, et al. Barrett's esophagus. A prevalent, occult complication of gastroesophageal reflux disease. Gastroenterology 1987; 92:118.
  13. Spechler SJ. Clinical practice. Barrett's Esophagus. N Engl J Med 2002; 346:836.
  14. Bersentes K, Fass R, Padda S, et al. Prevalence of Barrett's esophagus in Hispanics is similar to Caucasians. Dig Dis Sci 1998; 43:1038.
  15. Abrams JA, Fields S, Lightdale CJ, Neugut AI. Racial and ethnic disparities in the prevalence of Barrett's esophagus among patients who undergo upper endoscopy. Clin Gastroenterol Hepatol 2008; 6:30.
  16. Corley DA, Kubo A, Levin TR, et al. Race, ethnicity, sex and temporal differences in Barrett's oesophagus diagnosis: a large community-based study, 1994-2006. Gut 2009; 58:182.
  17. Shiota S, Singh S, Anshasi A, El-Serag HB. Prevalence of Barrett's Esophagus in Asian Countries: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2015; 13:1907.
  18. Kamat P, Wen S, Morris J, Anandasabapathy S. Exploring the association between elevated body mass index and Barrett's esophagus: a systematic review and meta-analysis. Ann Thorac Surg 2009; 87:655.
  19. Jacobson BC, Chan AT, Giovannucci EL, Fuchs CS. Body mass index and Barrett's oesophagus in women. Gut 2009; 58:1460.
  20. Corley DA, Kubo A, Levin TR, et al. Abdominal obesity and body mass index as risk factors for Barrett's esophagus. Gastroenterology 2007; 133:34.
  21. Edelstein ZR, Farrow DC, Bronner MP, et al. Central adiposity and risk of Barrett's esophagus. Gastroenterology 2007; 133:403.
  22. Kramer JR, Fischbach LA, Richardson P, et al. Waist-to-hip ratio, but not body mass index, is associated with an increased risk of Barrett's esophagus in white men. Clin Gastroenterol Hepatol 2013; 11:373.
  23. Omer ZB, Ananthakrishnan AN, Nattinger KJ, et al. Aspirin protects against Barrett's esophagus in a multivariate logistic regression analysis. Clin Gastroenterol Hepatol 2012; 10:722.
  24. Thrift AP, Pandeya N, Smith KJ, et al. The use of nonsteroidal anti-inflammatory drugs and the risk of Barrett's oesophagus. Aliment Pharmacol Ther 2011; 34:1235.
  25. Khalaf N, Nguyen T, Ramsey D, El-Serag HB. Nonsteroidal anti-inflammatory drugs and the risk of Barrett's esophagus. Clin Gastroenterol Hepatol 2014; 12:1832.
  26. Chak A, Lee T, Kinnard MF, et al. Familial aggregation of Barrett's oesophagus, oesophageal adenocarcinoma, and oesophagogastric junctional adenocarcinoma in Caucasian adults. Gut 2002; 51:323.
  27. Verbeek RE, Spittuler LF, Peute A, et al. Familial clustering of Barrett's esophagus and esophageal adenocarcinoma in a European cohort. Clin Gastroenterol Hepatol 2014; 12:1656.
  28. Orloff M, Peterson C, He X, et al. Germline mutations in MSR1, ASCC1, and CTHRC1 in patients with Barrett esophagus and esophageal adenocarcinoma. JAMA 2011; 306:410.
  29. Eloubeidi MA, Provenzale D. Does this patient have Barrett's esophagus? The utility of predicting Barrett's esophagus at the index endoscopy. Am J Gastroenterol 1999; 94:937.
  30. Kim SL, Waring JP, Spechler SJ, et al. Diagnostic inconsistencies in Barrett's esophagus. Department of Veterans Affairs Gastroesophageal Reflux Study Group. Gastroenterology 1994; 107:945.
  31. Ronkainen J, Talley NJ, Storskrubb T, et al. Erosive esophagitis is a risk factor for Barrett's esophagus: a community-based endoscopic follow-up study. Am J Gastroenterol 2011; 106:1946.
  32. Kim SL, Wo JM, Hunter JG, et al. The prevalence of intestinal metaplasia in patients with and without peptic strictures. Am J Gastroenterol 1998; 93:53.
  33. Riddell RH, Odze RD. Definition of Barrett's esophagus: time for a rethink--is intestinal metaplasia dead? Am J Gastroenterol 2009; 104:2588.
  34. American Gastroenterological Association, Spechler SJ, Sharma P, et al. American Gastroenterological Association medical position statement on the management of Barrett's esophagus. Gastroenterology 2011; 140:1084.
  35. Spechler SJ. The role of gastric carditis in metaplasia and neoplasia at the gastroesophageal junction. Gastroenterology 1999; 117:218.
  36. Sharma P, Morales TG, Sampliner RE. Short segment Barrett's esophagus--the need for standardization of the definition and of endoscopic criteria. Am J Gastroenterol 1998; 93:1033.
  37. Spechler SJ. Intestinal metaplasia at the gastroesophageal junction. Gastroenterology 2004; 126:567.
  38. Fawcett DW. The esophagus and stomach. In: A Textbook of Histology, 11th ed, Bloom W, Fawcett DW (Eds), Saunders Company, Philadelphia 1986. p.619.
  39. Amano Y, Ishimura N, Furuta K, et al. Which landmark results in a more consistent diagnosis of Barrett's esophagus, the gastric folds or the palisade vessels? Gastrointest Endosc 2006; 64:206.
  40. Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett's esophagus: the Prague C & M criteria. Gastroenterology 2006; 131:1392.
  41. Alvarez Herrero L, Curvers WL, van Vilsteren FG, et al. Validation of the Prague C&M classification of Barrett's esophagus in clinical practice. Endoscopy 2013; 45:876.
  42. HAYWARD J. The lower end of the oesophagus. Thorax 1961; 16:36.
  43. Chandrasoma P. Pathophysiology of Barrett's esophagus. Semin Thorac Cardiovasc Surg 1997; 9:270.
  44. Oberg S, Peters JH, DeMeester TR, et al. Inflammation and specialized intestinal metaplasia of cardiac mucosa is a manifestation of gastroesophageal reflux disease. Ann Surg 1997; 226:522.
  45. Dresner SM, Griffin SM, Wayman J, et al. Human model of duodenogastro-oesophageal reflux in the development of Barrett's metaplasia. Br J Surg 2003; 90:1120.
  46. Sharma P, Weston AP, Morales T, et al. Relative risk of dysplasia for patients with intestinal metaplasia in the distal oesophagus and in the gastric cardia. Gut 2000; 46:9.
  47. Jung KW, Talley NJ, Romero Y, et al. Epidemiology and natural history of intestinal metaplasia of the gastroesophageal junction and Barrett's esophagus: a population-based study. Am J Gastroenterol 2011; 106:1447.
  48. Loughney T, Maydonovitch CL, Wong RK. Esophageal manometry and ambulatory 24-hour pH monitoring in patients with short and long segment Barrett's esophagus. Am J Gastroenterol 1998; 93:916.
  49. Sharma P, Morales TG, Bhattacharyya A, et al. Dysplasia in short-segment Barrett's esophagus: a prospective 3-year follow-up. Am J Gastroenterol 1997; 92:2012.
  50. Weston AP, Krmpotich PT, Cherian R, et al. Prospective long-term endoscopic and histological follow-up of short segment Barrett's esophagus: comparison with traditional long segment Barrett's esophagus. Am J Gastroenterol 1997; 92:407.
  51. Rudolph RE, Vaughan TL, Storer BE, et al. Effect of segment length on risk for neoplastic progression in patients with Barrett esophagus. Ann Intern Med 2000; 132:612.
  52. Inadomi JM, Sampliner R, Lagergren J, et al. Screening and surveillance for Barrett esophagus in high-risk groups: a cost-utility analysis. Ann Intern Med 2003; 138:176.
  53. DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 1999; 94:1434.
  54. Rubenstein JH, Taylor JB. Meta-analysis: the association of oesophageal adenocarcinoma with symptoms of gastro-oesophageal reflux. Aliment Pharmacol Ther 2010; 32:1222.
  55. Rubenstein JH, Scheiman JM, Sadeghi S, et al. Esophageal adenocarcinoma incidence in individuals with gastroesophageal reflux: synthesis and estimates from population studies. Am J Gastroenterol 2011; 106:254.
  56. Lagergren J, Bergström R, Lindgren A, Nyrén O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999; 340:825.
  57. Dulai GS, Guha S, Kahn KL, et al. Preoperative prevalence of Barrett's esophagus in esophageal adenocarcinoma: a systematic review. Gastroenterology 2002; 122:26.
  58. Shaheen NJ, Dulai GS, Ascher B, et al. Effect of a new diagnosis of Barrett's esophagus on insurance status. Am J Gastroenterol 2005; 100:577.
  59. Shaheen NJ, Weinberg DS, Denberg TD, et al. Upper endoscopy for gastroesophageal reflux disease: best practice advice from the clinical guidelines committee of the American College of Physicians. Ann Intern Med 2012; 157:808.
  60. ASGE Standards of Practice Committee, Evans JA, Early DS, et al. The role of endoscopy in Barrett's esophagus and other premalignant conditions of the esophagus. Gastrointest Endosc 2012; 76:1087.
  61. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013; 108:308.
  62. Kadri SR, Lao-Sirieix P, O'Donovan M, et al. Acceptability and accuracy of a non-endoscopic screening test for Barrett's oesophagus in primary care: cohort study. BMJ 2010; 341:c4372.