According to estimates put forth in a study published today in the American Gastroenterological Association (AGA) journal Gastroenterology, more than 3 million Americans are living with Barrett's esophagus, a condition that leads to esophageal cancer, one of the most rapidly increasing cancers in the United States. These findings represent the first population-based estimates of the prevalence of Barrett's esophagus and show how frequently the disease occurs in people who do not have gastroesophageal reflux disease (GERD), commonly thought to be a precursor to Barrett's.
"The definition put forth in this study of the prevalence of Barrett's esophagus in the general adult population represents a major step forward," said Richard E. Sampliner, MD, author of an editorial appearing in this month's Gastroenterology from the Southern Arizona VA Health Care System. "The next step for researchers and practitioners is to focus on screening for Barrett's in people without reflux disease and accurately identifying those at-risk or living with the disease."
Researchers at the Karolinska Institutet, the Mayo Clinic College of Medicine and the Institute of Pathology in Bayreuth conducted a study using nearly 3,000 residents of two neighboring communities in Northern Sweden. Patients were sent an invitation to participate in the study via mail and a health questionnaire. Following in-depth data collection and interviewing, 1,000 participants underwent an upper endoscopy to determine the presence of Barrett's esophagus. The study showed that nearly 2 percent of the general population tested had Barrett's esophagus--a rate that when applied to the general population of the United States, translates into nearly 3 million Americans.
"Barrett's esophagus is associated with one of the most rapidly increasing cancers in the Western World and to this point, data on the prevalence of the disease in the general population have been unavailable," said Jukka Ronkainen, MD, lead study author from the Karolinska Institutet in Sweden. "This Swedish-based study has helped lay the foundation for researching the true prevalence of Barrett's and could serve as a basis for future studies in different communities."
Beyond providing the number of people potentially affected by Barrett's, this study gives insight into those who might be most vulnerable for developing the disease. According to study findings, Barrett's was nearly twice as prevalent in people with symptoms of reflux and those who had esophagitis than those who did not. However, more than 40 percent of those who presented with the disease had no prior symptoms of reflux--giving credence to the theory that Barrett's can significantly impact people who present with no symptoms and that screening only those with reflux will not effectively capture all cases. The study also shows that alcohol consumption and smoking are significant risk factors for developing Barrett's.
"We hope our study findings provide more than just a basis for screening initiatives, but we also hope it raises awareness among patients and physicians of how common Barrett's esophagus is in the general population," said Dr. Ronkainen. "Those people who present with other Barrett's symptoms sans reflux should not be discounted as potentially having the disease. Finding these people will definitely provide a challenge for the medical and public health communities."
Barrett's esophagus results from a severe pathological change in the lining of the esophagus, typically in patients who suffer from GERD. Symptoms of Barrett's include heartburn, waking during the night due to heartburn pain and acid regurgitation. However, some people with Barrett's don't show symptoms of the disease and it often goes undiagnosed for years. While the exact cause of Barrett's is not clear, people with chronic GERD, obese people, men and Caucasians are at greater risk of developing the disease. Barrett's is the primary cause of esophageal cancer, one of the most rapidly increasing cancers in the United States.
This study was made possible in part by the Swedish Research Council, the Swedish Society of Medicine and AstraZeneca R&D (Sweden).
More information on Barrett's esophagus and esophageal cancer is available at www.gastro.org.
About the AGA
The American Gastroenterological Association (AGA) is dedicated to the mission of advancing the science and practice of gastroenterology. Founded in 1897, the AGA is the oldest medical-specialty society in the United States. Comprised of two non-profit organizations--the AGA and the AGA Institute--our more than 14,500 members include physicians and scientists who research, diagnose and treat disorders of the gastrointestinal tract and liver. The AGA, a 501(c6) organization, administers all membership and public policy activities, while the AGA Institute, a 501(c3) organization, runs the organization's practice, research and educational programs. On a monthly basis, the AGA Institute publishes two highly respected journals, Gastroenterology and Clinical Gastroenterology and Hepatology. The organization's annual meeting is Digestive Disease Week®, which is held each May and is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
Gastroenterology, the official journal of the AGA, is the most prominent journal in the subspecialty and is in the top one percent of indexed medical journals internationally. The journal publishes clinical and basic studies of all aspects of the digestive system, including the liver and pancreas, as well as nutrition. The journal is abstracted and indexed in Biological Abstracts, CABS, Chemical Abstracts, Current Contents, Excerpta Medica, Index Medicus, Nutrition Abstracts and Science Citation Index. For more information, visit www.gastrojournal.org.
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