Prevalence of Barrett's esophagus in asymptomatic individuals.
OBJECTIVE
The incidence of esophageal adenocarcinoma in the western world has been linked to chronic heartburn, regurgitation, and the development of the premalignant epithelium of Barrett's esophagus (BE). However, up to 40% of esophageal adenocarcinomas occur in patients without prior reflux symptoms. We prospectively screened for the presence of BE in asymptomatic subjects older than 50 years of age undergoing screening sigmoidoscopy for colorectal cancer.


METHODS
Subjects undergoing sigmoidoscopy for colorectal cancer (CRC) screening were invited to undergo upper endoscopy. Exclusion criteria included symptoms of gastroesophageal reflux disease (GERD) more than once a month, use of medications for GERD, or previous endoscopy. BE was classified as long-segment BE (LSBE), short-segment BE (SSBE), and microscopic specialized intestinal metaplasia of the esophagogastric junction (SIM-EGJ).


RESULTS
Of 408 potential study candidates, 110 subjects were screened; 9 were women. The mean (+/-SD) age was 61 +/- 9.3 (range, 50-80) years, most of them (73%) Caucasian. Intestinal metaplasia (IM) extending above the EGJ was detected in 27 (25%) subjects; 8 (7%) had LSBE, and 19 (17%) had SSBE. Patients with BE were no more likely to be obese, consumers of tobacco or alcohol, report a family history of GERD, show association with toxic exposure, or use antacids more than once a month, compared with those without BE.


CONCLUSIONS
BE was detected in 25% of asymptomatic male veterans older than 50 years of age undergoing screening sigmoidoscopy for CRC.
Gerson
Lauren B
LB
Section of Gastroenterology, VA Palo Alto Health Care System and Division of Gastroenterology, Stanford University School of Medicine, Stanford, California 94305-5202, USA. lgerson@leland.stanford.edu
Shetler
Katerina
K
Triadafilopoulos
George
G
D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking; D001471:Barrett Esophagus / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D015992:Body Mass Index; D004938:Esophageal Neoplasms / Q000209:etiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D006801:Humans; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D015995:Prevalence; D012907:Smoking / Q000009:adverse effects