Clinical Question: How common is Barrett's esophagus, and what is the relationship between gastroesophageal reflux symptoms and Barrett's esophagus?

Setting: Population-based

Study Design: Cross-sectional

Synopsis: Although approximately 0.5 to 1.0 percent of patients with Barrett's esophagus develop adenocarcinoma of the esophagus each year, the relationship between reflux symptoms and Barrett's esophagus is less clear. Many patients with esophageal cancer have no reflux symptoms at all. In this study, researchers contacted every seventh person in two neighboring communities in northern Sweden (n = 3,000), of whom 2,860 were available at the time of the study. Of this group, 2,122 (74 percent) completed a validated survey of abdominal symptoms by mail. The researchers then approached those who had completed the survey to request that they come in for upper endoscopy; 73 percent agreed.

The participants were similar to the overall population with the exception that they were a mean of 3.7 years older (because of lower participation among symptom-free younger patients). In this way, a group of 1,000 patients who were fairly representative of the general population were assembled to undergo upper endoscopy. Their mean age was 53.5 years, and 51 percent were women. Barrett's esophagus was found in 1.6 percent of the study population, including 2.3 percent of those with reflux symptoms and 1.2 percent of those without reflux symptoms (P = .18).

More patients did not have reflux than had reflux in the study population, and only 56 percent of patients with Barrett's esophagus complained of ref lux symptoms. The prevalence of Barrett's esophagus was 2.6 percent in those patients with esophagitis seen on endoscopy and 1.4 percent in those without objective evidence of esophagitis (P = .32); only 25 percent of those with Barrett's esophagus also had esophagitis. Barrett's esophagus was more common in patients who smoked, drank alcohol, or had a hiatal hernia.

Bottom Line: Barrett's esophagus is uncommon, and a large percentage of patients with Barrett's esophagus do not have reflux symptoms. (Level of Evidence: 1b)