Prevalence of Barrett's Esophagus in Asian Countries: A Systematic Review and Meta-analysis

Seiji Shiota, Siddharth Singh, Ashraf Anshasi, Hashem B El-Serag, Seiji Shiota, Siddharth Singh, Ashraf Anshasi, Hashem B El-Serag

Abstract

Background & aims: The prevalence and risk factors of Barrett's esophagus (BE) in Asian countries are unclear. Studies report a wide range of BE prevalence in Asian countries. We conducted a systematic review and meta-analysis to examine the prevalence of BE and its temporal changes and risk factors in Asian countries.

Methods: Two investigators performed independent literature searches by using PubMed and EMBASE databases, and subsequent data abstraction for studies had to meet several set inclusion and exclusion criteria. Pooled BE prevalence was calculated by using a random-effect model. Estimates of relative risk for possible risk or protective factors were also calculated.

Results: A total of 51 studies (N = 453,147), mainly from Eastern Asia, were included. The pooled prevalence of endoscopic BE was 7.8% (95% confidence interval, 5.0-12.1; 23 studies) and of histologically confirmed BE was 1.3% (95% confidence interval, 0.7-2.2; 28 studies). Most of histologic BE (82.1%) was short-segment BE (<3 cm). There was a trend toward an increase in prevalence of BE over time from 1991 to 2014, especially in Eastern Asian countries. Within BE cohorts, pooled prevalence of low-grade dysplasia, high-grade dysplasia, and esophageal adenocarcinoma was 6.9%, 3.0%, and 2.0%, respectively. Reflux symptoms, male sex, hiatus hernia, and smoking were associated with a significantly increased risk of histologic BE in patients with BE compared with patients without BE. However, half of the patients with histologic BE did not have reflux symptoms.

Conclusions: BE is not uncommon in Asian countries and seems to share similar risk factors and potential for neoplastic progression to those seen in Western countries.

Keywords: Barrett’s Esophagus; Meta-analysis; Prevalence; Risk Factors; Systematic Review.

Conflict of interest statement

Disclosures

The authors disclose no conflicts.

Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Flowchart of systematic literature searches.
Figure 2
Figure 2
Prevalence of histologic BE (N = 28 studies) (a) and endoscopic BE only (23 studies) (b)
Figure 2
Figure 2
Prevalence of histologic BE (N = 28 studies) (a) and endoscopic BE only (23 studies) (b)
Figure 3
Figure 3
Prevalence of histologic BE (a) and endoscopic BE (b) categorized by Eastern Asian countries.
Figure 4
Figure 4
Prevalence of low (a) or high grade dysplasia (b) and esophageal adenocarcinoma (c) in the patients with histologic BE
Figure 4
Figure 4
Prevalence of low (a) or high grade dysplasia (b) and esophageal adenocarcinoma (c) in the patients with histologic BE
Figure 5
Figure 5
Association between the risk of histologic BE and gender (N = 16 studies) (a) and reflux symptoms (N = 10 studies) (b) in Asian studies
Figure 5
Figure 5
Association between the risk of histologic BE and gender (N = 16 studies) (a) and reflux symptoms (N = 10 studies) (b) in Asian studies

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe