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Barrett's Oesophagus Incidence

Study
Results
Comment

Barrett's oesophagus is where squamous epithelium is replaced with columnar epithelium. Probably caused by prolonged reflux of acid into the oesophagus, it is a major risk factor for oesophageal cancer, increasing the risk by 30-100 fold. The incidence of oesophageal cancer is rising, and a study [1] tells us that Barrett's incidence is also rising.

Study


This was an integrated database study from Holland, based on over half a million patient records maintained since 1992. Patients contributing data between 1996 and 2003 inclusive involved 386,000 patients for 1.3 million person years of follow up. The database gave details of patients having upper gastrointestinal endoscopy, and the results of the endoscopy. Incidence was calculated by dividing the number of cases by the population at risk.

Results


There were 491 definite or probable cases of Barrett's oesophagus after medical record review. The incidence of Barrett's oesophagus for each 100,000 patient years and per 1000 endoscopies is shown in Figure 1. The 10-year risk of being diagnosed with Barrett's oesophagus rose with agefrom 0.1% in the early 30s to almost 1% at 70 years. There were more men (61%) than women, and the mean age at diagnosis was lower (59 years) in men than in women (66 years).


Figure 1: Annual incidence of Barrett's oesophagus detected by endoscopy, for population and for endoscopies conducted






Adenocarcinoma of the oesophagus was detected in 51 patients over the period, 76% in men, at a mean age of about 70 years. The incidence increased threefold over the period, and was 6 (95% confidence interval 3-10) per 100,000 person years in 2002. It could be higher, because some cases of unknown type were omitted.

Comment


Obesity and acid reflux are two major risk factors for Barrett's oesophagus, and these findings are likely to be another manifestation of the fattening of populations. Endoscopy was largely driven by guidelines for reflux, and not all patients with Barrett's oesophagus have reflux, so the actual incidence could be higher.

Reference:


  1. EM van Soest et al. Increasing incidence of Barrett's oesophagus in the general population. Gut 2005 54: 1062-1066.

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