1. The Prevalence of and Risk Factors for Barrett Esophagus in a Korean Population - A Nationwide Multicenter Prospective Study -
J Clin Gastroenterol 2009
R2 Hongjoo Lee
Prof. Jae-Young Jang

2. Background Barrett esophagus (BE)
: Presence of columnar epithelium lining the distal esophagus, of any length, with specialized intestinal metaplasia characterized by acid mucin-containing goblet cells
Prevalence in Western countries
long segment Barrett esophagus : 1~2%
short segment Barrett esophagus (SSBE) : 6~12%
3% to 9% to 13% of patients with reflux symptoms.
Eastern Asia < Western countries
Objective : prospective study
: prevalence of and risk factors for BE in the general Korean population screening esophagogastroduodenoscopy (EGD)

3. Methods Subjects January 2006 ~ July 2006
Healthcare centers of 40 hospitals nationwide in 7 different provinces
25,536 subjects
screening EGD during a routine general check-up
Exclusion Criteria
history of gastrointestinal surgery
systemic disease requiring chronic medication (except HTN and DM)
Inclusion Criteria
over 16 y of age
agreed to participate in this nationwide survey
completion of the gastroesophageal reflux questionnaire
agreed to undergo an endoscopy

4. Methods Gastroesophageal reflux questionnaire (14 items)
7 reflux symptoms
heartburn
acid regurgitation
chest pain
hoarseness
globus sensation
cough
epigastric soreness
7 factors related to gastroesophageal reflux
drug history
comorbid disease
history of H. pylori eradication
alcohol consumption
smoking
stooping posture at work
monthly income
most irritating symptom
grade the severity
a : mild
b : moderate, bothersome to everyday life
c : severely disturbing work or sleeping
whether they had taken
H2 blockers or PPI +

5. Methods Esophagogastric Examination presence of endoscopic BE
squamous-columnar junction
length of the BE
long ≥ 3.0 cm
short < 3.0 cm
form of the BE : ie, tongue-like projection, circumferential, island of CLE
RE : according to the Los Angeles classification

6. Methods Pathology Examination
Systematic 4-quadrant biopsy specimens at 1cm intervals
from the endoscopically identified columnar (pink) mucosa contain metaplastic or intestinalized columnar epithelium with goblet cells
by H-E staining and Alcian blue staining (pH 2.5)
Disagreement → reexamined by both pathologists
until agreement was reached

7. Methods Statistical Analysis Categorization
Age : by 10-year age intervals.
Smoking and alcohol consumption : binary variables by the current status
BMI : by the cut-off points of 23 and 25 (kg/m2)
blood glucose and cholesterol levels : standard clinical cut-off points
Chi-square tests
x2 tests
Hosmer-Lemeshow goodness-of-fit test
SAS statistical software(SAS Institute, Cary, NC)
P value < 0.05 : statistically significant.

8. Results
Characteristics of Participating Subjects and Endoscopic Findings
25,536 subjects
men 15,180(59.45%)
women 10,356(40.55%)
Mean subject age : 46.7±11.1 years
Males, 40~59 age group, Seoul population, higher income and education
RE : 2019 subjects (7.91%)
Endoscopically suspected BE(ESBE) : 864 subjects (3.4%)
peptic ulcer or malignancy, male sex, ≥ 50 years of age
: BE subjects>normal population
ESBE
864
Biopsies
642(74.3%) BE
215(33.5%)
Not
222(25.7%)
Columnar epithelium
386 (90.4%)
Squamous epithelium
41 (9.6%)

9. Results
Table 1. Comparison of Normal Population and Subjects With Barrett Esophagus
TABLE 1. Comparison of Normal Population and Subjects With Barrett Esophagus

10. Results
Subgroup Analysis of BE According to the Length and Form of BE, and the Presence of RE
length BE : 215 subjects with BE
< 10mm : 167(77.7%)
10 to 9mm : 38 (17.7%)
≥ 20mm10 (4.6%)
form of BE
tongue-like projections : 159 subjects (74.0%),
circumferential formation : 56 (26.0%)
islands of columnar epithelium : 47 (21.9%)
islands of squamous epithelium : 9 (3.7%)
≥ 2 different patterns : 56
presence or absence of RE
absence of RE : 167(77.7%)
Presence of RE : 48 (22.3%)
: no statistically significant differences - sex ratio, age, distribution of length, and forms of BE between the 2 groups.

11. Results
Clinical Spectrum of BE Table 2. Comparison of Reflux Symptoms Between Normal and Barrett Esophagus

12. Results Clinical Spectrum of BE
Table 3 Comparison of Reflux Symptoms of Barrett Esophagus According to the Presence of Reflux Esophagitis

13. Results Risk Factors for BE
Table 4. Risk Factors by Multivariate Analysis According to the Association of Reflux Esophagitis With Barrett Esophagus

14. Conclusions
Prevalence of BE in Korean patients for a routine health check-up
: 0.84% - lower than reported in Western countries
Among the subjects with BE
77.7% : no endoscopic erosions
39.9% : no reflux symptoms
Regular endoscopic screening with a high index of suspicion is necessary for the diagnosis of BE.