What is the prevalence of BO in the Australian population in comparison with other populations?

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What is the prevalence of BO in the Australian population in comparison with other populations?

Introduction

There are a large number of studies reporting the prevalence of Barrett’s Oesophagus (BO) from various countries around the world. The majority of these studies are cross-sectional in design and the sample sizes vary from less than 50 patients to more than 280,000 patients. The main limitations associated with the studies include the definition of Barrett’s Oesophagus, the diagnostic criteria used with some endoscopic only and other studies including histopathologic verification, and the selection of patients. These factors and others may explain the substantial variation in the prevalence of Barrett’s Oesophagus reported globally. Australian data are limited and future well designed large studies should be undertaken to improve the estimates of Barrett’s Oesophagus among various population groups in Australia.

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Australian prevalence of Barrett’s Oesophagus

There are only three studies reporting prevalence estimates conducted in Australian populations.[1][2][3] The first study reported on a consecutive sample of endoscopy patients (n=158) from a Sydney hospital (Nepean) and they specifically report the number of short segment Barrett’s Oesophagus (n=46, 36%). Moreover, Barrett’s Oesophagus was more common among females (65%) and those who were older (56 years versus 48 years, p=0.009).[1] In a 2006 published study which involved a record linkage data analysis of a region of Brisbane with a population of 376,907 individuals. The analysis which assessed all oesophageal biopsies over the time frame compared rates of Barrett’s oesophagus at three different time points (1990, 1998, 2002). The prevalence rates at each of the time points were 0.29% (1990), 1.44% (1998), and 1.89% (2002).[3] The final study was conducted on 2,153 patients undergoing anti-reflux surgery found that males were twice as likely to have Barrett’s Oesophagus (18.4%) compared to females (9.2%).[2] Overall, there are no studies describing the prevalence of Barrett’s Oesophagus in an asymptomatic, unselected Australian population. One small study suggests a high prevalence in specific high-risk patient populations, and two larger studies in different groups of symptomatic patients having a lower prevalence.

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Barrett’s Oesophagus in the Middle East

There are four studies from the Middle East reporting prevalence rates of Barrett’s Oesophagus.[4][5][6][7] There were no population-based studies, and the prevalence of Barrett’s Oesophagus ranges were from 3.3%[5] to 7.3%.[6] The groups assessed included select groups such as those with chronic gastro-oesophageal reflux symptoms or dyspepsia. Prevalence varied significantly by gender with males more likely to be affected and those who were older (>50 years).[7]

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Barrett’s Oesophagus in South America

There are three studies from South America reporting prevalence rates of Barrett’s Oesophagus.[8][9][10] There were no population-based studies, and the prevalence of Barrett’s Oesophagus ranges were from 1.6%[10] to 30.8%.[9] All studies compared individuals with gastro-oesophageal reflux symptoms. Reflux patients had higher rates of Barrett’s compared with controls.[10][9]

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Barrett’s Oesophagus in Asia

There are 23 studies from Asia reporting prevalence rates of Barrett’s Oesophagus.[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] There were no population-based studies, however, there were several large ‘health check’ studies and the prevalence of Barrett’s Oesophagus ranges were from 0.06%[26] to 37.7%.[22] The prevalence was low in Malaysia (<5%) with Barrett’s patients more likely to occur in females and those of Indian ethnicity.[19][33] In China, the average prevalence was around 6% with most cases likely to be male.[19][18] In Taiwan, the prevalence was <2%, patients were more likely to be >60 years and were male.[11][26][27][30] Japan had higher prevalence estimates (~20%) and patients were more likely to be >60 years and male.[12][17][22][25] The prevalence was around 6% in Korea and patients were more likely to be older and male.[16][18][31][21][23][24][28] A single study from India had a prevalence of 6% and patients were more likely to be older and male.[13]

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Barrett’s Oesophagus in Europe

There are 15 studies from Europe reporting prevalence rates of Barrett’s Oesophagus.[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] There was only one population-based endoscopic study assessing the prevalence of Barrett’s which was conducted in Finland (n=1,000), the rate was 1.6% and the majority of patients were female (69%).[39] Other endoscopic studies reported the prevalence of Barrett’s Oesophagus ranged between 0.06%[38] and 33%.[48] Studies from Turkey generally had low rates of Barrett’s Oesophagus (<8%), and the patients were older and more likely to be male.[36][40][43][44] The Netherlands produced the lowest prevalence of 0.06%[38] and one of the largest 31%,[41] but most studies were <5%.[42] In the United Kingdom studies ranged from 1.4%[35] to 33%,[48] again mostly males affected. A German study found a 18% prevalence, with two-thirds being male.[34] Conversely, a Swedish study reported a 4% prevalence with 69% of patients being female.[37] Studies from Spain,[45] Lithuania[47] and Italy[46] all reported a <1% prevalence of Barrett’s Oesophagus.

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Barrett’s Oesophagus in the United States

There are 26 studies from the United States reporting prevalence rates of Barrett’s Oesophagus.[49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] There were no population-based studies and the prevalence of Barrett’s Oesophagus ranges from 0.25%[61] to 28.4%.[68] Generally the prevalence was low (<10%) for all studies in the United States. However, there were several studies comparing different ethnicities and these reported higher rates among Caucasians, followed by Hispanics, African Americans, then Asians.[52][67][70][71]

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Summary

The prevalence of Barrett’s oesophagus varies by geography and ethnicity, however, the prevalence is generally low (<5%), except for those with gastro-oesophageal reflux symptoms or disease, older individuals (>55 years), and male gender. In certain ethnic populations, such as Asians the prevalence of Barrett’s oesophagus is very low (<1%).

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Evidence summary and recommendations

Practice pointQuestion mark transparent.png

Globally, the prevalence of Barrett’s Oesophagus is generally low (<5%) and only in selected groups such as those with gastro-oesophageal reflux disease is it substantially higher (>15%). Prevalence also varies significantly by different ethnicities (e.g., Asians <1% prevalence) and by gender (i.e. more common in males).

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Issues requiring more clinical research study

  • Is there any importance in the variation of short and long segment Barrett’s Oesophagus among different populations/ethnicities?
  • Australian data are limited and future well designed large studies should be undertaken to improve the estimates of Barrett’s Oesophagus among various population groups in Australia.


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References

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