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Journal of Gastroenterology

, Volume 43, Issue 12, pp 928–934 | Cite as

Barrett’s esophagus in Japanese patients: its prevalence, form, and elongation

  • Koichi Okita
  • Yuji Amano
  • Yoshiko Takahashi
  • Yuko Mishima
  • Nobuyuki Moriyama
  • Norihisa Ishimura
  • Shunji Ishihara
  • Yoshikazu Kinoshita
Alimmentary Tract

Abstract

Background

Barrett’s esophagus is a well-known acquired condition resulting from gastroesophageal reflux disease (GERD). However, it is still unknown whether Barrett’s esophagus develops gradually over time in patients with GERD. To address this issue, we investigated the change in the prevalence and length of short-segment Barrett’s esophagus (SSBE) over time.

Methods

From January 2005 to March 2007, we enrolled 5338 patients who received upper gastrointestinal endoscopy. Prevalence and length of endoscopically identified SSBE were evaluated within groups divided on the basis of 10-year age intervals. The factors possibly influencing SSBE length such as symptoms, antacid use, and endoscopic findings were also evaluated. Additionally, the length change in 236 patients with histologically confirmed Barrett’s esophagus was evaluated over a 2-year follow-up.

Results

Of the 5338 enrolled patients, 1997 had SSBE. The prevalence of endoscopically identified SSBE was significantly higher and its length was significantly longer in elderly patients. Multiple regression analysis showed that age, presence of reflux esophagitis, reflux symptoms, and hiatal hernia were positively correlated with SSBE length. Analysis of the 2-year follow-up study of histologically confirmed SSBE revealed significant extension of Barrett’s length in 28.0% of 236 patients. Presence of reflux symptoms and hiatal hernia were identified as positive predictors and proton pump inhibitor administration as a negative predictor of SSBE elongation.

Conclusions

Positive predictors for the extension of SSBE were presence of hiatal hernia and reflux symptoms, but not age.

Key words

Barrett’s esophagus prevalence elongation 

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References

  1. 1.
    Cameron AJ, Zinsmeister AR, Ballard DJ, Carney JA. Prevalence of columnar-lined (Barrett’s) esophagus. Comparison of population-based clinical and autopsy findings. Gastroenterology 1990;99:918–922.PubMedGoogle Scholar
  2. 2.
    Pera M, Cameron AJ, Trastek VF, Carpenter HA, Zinsmeister AR. Increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction. Gastroenterology 1993;104:510–513.PubMedGoogle Scholar
  3. 3.
    Fass R, Ofman JJ. Gastroesophageal reflux disease-should we adopt a new conceptual framework? Am J Gastroenterol 2002;97:1901–1909.PubMedGoogle Scholar
  4. 4.
    Cameron AJ, Lomboy CT. Barrett’s esophagus: age, prevalence, and extent of columnar epithelium. Gastroenterology 1992;103:1241–1245.PubMedGoogle Scholar
  5. 5.
    Fass R, Hell RW, Garewal HS, Martinez P, Pulliam G, Wendel C, et al. Correlation of oesophageal acid exposure with Barrett’s oesophagus length. Gut 2001;48:310–313.PubMedCrossRefGoogle Scholar
  6. 6.
    Tharalson EF, Martinez SD, Garewal HS, Sampliner RE, Cui H, Pulliam G, et al. Relationship between rate of change in acid exposure along the esophagus and length of Barrett’s epithelium. Am J Gastroenterol 2002;97:851–856.PubMedCrossRefGoogle Scholar
  7. 7.
    Peters FT, Ganesh S, Kuipers EJ, Sluiter WJ, Klinkenberg-Knol EC, Lamers CB, et al. Endoscopic regression of Barrett’s oesophagus during omeprazole treatment; a randomised double blind study. Gut 1999;45:489–494.PubMedGoogle Scholar
  8. 8.
    Malesci A, Savarino V, Zentilin P, Belicchi M, Mela GS, Lapertosa G, et al. Partial regression of Barrett’s esophagus by longterm therapy with high-dose omeprazole. Gastrointest Endosc 1996;44:700–705.PubMedCrossRefGoogle Scholar
  9. 9.
    Schell TG. Acid suppression and adenocarcinoma of the esophagus: cause or cure? Am J Gastroenterol 2004;99:1884–1886.PubMedCrossRefGoogle Scholar
  10. 10.
    El-Serag HB, Aguirre TV, Davis S, Kuebeler M, Bhattacharyya A, Sampliner RE. Proton pump inhibitors are associated with reduced incidence of dysplasia in Barrett’s esophagus. Am J Gastroenterol 2004;99:1877–1883.PubMedCrossRefGoogle Scholar
  11. 11.
    Hillman LC, Chiragakis L, Shadbolt B, Kaye GL, Clarke AC. Proton-pump inhibitor therapy and the development of dysplasia in patients with Barrett’s oesophagus. Med J Aust 2004;180:387–391.PubMedGoogle Scholar
  12. 12.
    Sharma P, Sampliner RE, Camargo E. Normalization of esophageal pH with high-dose proton pump inhibitor therapy does not result in regression of Barrett’s esophagus. Am J Gastroenterol 1997;92:582–585.PubMedGoogle Scholar
  13. 13.
    Weston AP, Badr AS, Hassanein RS. Prospective multivariate analysis of factors predictive of complete regression of Barrett’s esophagus. Am J Gastroenterol 1999;94:3420–3426.PubMedCrossRefGoogle Scholar
  14. 14.
    Sharma P. Barrett esophagus: will effective treatment prevent the risk of progression to esophageal adenocarcinoma? Am J Med 2004;117Suppl 5A:79S–85S.PubMedGoogle Scholar
  15. 15.
    Carlsson R, Dent J, Bolling-Sternevald E, Johnsson F, Junghard O, Lauritsen K, et al. The usefulness of a structured questionnaire in the assessment of symptomatic gastroesophageal reflux disease. Scand J Gastroenterol 1998;33:1023–1029.PubMedCrossRefGoogle Scholar
  16. 16.
    Armstrong D. Review article: towards consistency in the endoscopic diagnosis of Barrett’s oesophagus and columnar metaplasia. Aliment Pharmacol Ther 2004;20Suppl 5:40–47.PubMedCrossRefGoogle Scholar
  17. 17.
    Sharma P, Dent J, Armstrong D, Bergman JJ, Gossner L, Hoshihara Y, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology 2006;131:1392–1399.PubMedCrossRefGoogle Scholar
  18. 18.
    Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999;45:172–180.PubMedGoogle Scholar
  19. 19.
    Amano K, Adachi K, Katsube T, Watanabe M, Kinoshita Y. Role of hiatus hernia and gastric mucosal atrophy in the development of reflux esophagitis in the elderly. J Gastroenterol Hepatol 2001;16:132–136.PubMedCrossRefGoogle Scholar
  20. 20.
    Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy 1969;3:87–97.CrossRefGoogle Scholar
  21. 21.
    Asayama M, Shibata M, Kondo Y, Tauchi M, Yanagawa T, Sato S, et al. Retrospective cohort study of chronological change of short-segment Barrett’s esophagus. Dig Endosc 2005;17:28–31.CrossRefGoogle Scholar
  22. 22.
    Gopal DV, Lieberman DA, Magaret N, Fennerty MB, Sampliner RE, Garewal HS, et al. Risk factors for dysplasia in patients with Barrett’s esophagus: results from a multicenter consortium. Dig Dis Sci 2003;48:1537–1541.PubMedCrossRefGoogle Scholar
  23. 23.
    Schnell TG, Sontag SJ, Chejfec G. Adenocarcinoma arising in tongues or short segments of Barrett’s esophagus. Dig Dis Sci 1992;37:137–143.PubMedCrossRefGoogle Scholar
  24. 24.
    Drewitz DJ, Sampliner RE, Garewal HS. The incidence of adenocarcinoma in Barrett’s esophagus: a prospective study of 170 patients followed 4.8 years. Am J Gastroenterol 1997;92:212–215.PubMedGoogle Scholar
  25. 25.
    Sharma P, Morales TG, Bhattacharyya A, Garewal HS, Sampliner RE. Dysplasia in short-segment Barrett’s esophagus: a prospective 3-year follow-up. Am J Gastroenterol 1997;92:2012–2016.PubMedGoogle Scholar
  26. 26.
    Hirota WK, Loughney TM, Lazas DJ, Maydonovitch CL, Rholl V, Wong RK. Specialized intestinal metaplasia, dysplasia, and cancer of the esophagus and esophagogastric junction: prevalence and clinical data. Gastroenterology 1999;116:277–285.PubMedCrossRefGoogle Scholar
  27. 27.
    Amano Y, Kushiyama Y, Ishihara S, et al. Barrett’s esophagus with predominant intestinal metaplasia correlates with superficial COX-2 expression, increased proliferation and reduced apoptosis: changes that are partially reversed by NSAIDs usage. Aliment Pharmacol Ther 2004;20:793–802.PubMedCrossRefGoogle Scholar
  28. 28.
    Amano Y, Kushiyama Y, Yuki T, Yuki T, Takahashi Y, Chinuki D, et al. Prevalence of and risk factors for Barrett’s esophagus with intestinal predominant mucin phenotype. Scand J Gastroenterol 2006;41:873–879.PubMedCrossRefGoogle Scholar
  29. 29.
    Dickman R, Green C, Chey WD, Jones MP, Eisen GM, Ramirez F, et al. Clinical predictors of Barrett’s esophagus length. Gastrointest Endosc 2005;62:675–681.PubMedCrossRefGoogle Scholar
  30. 30.
    Avidan B, Sonnenberg A, Schnell TG, Sontag SJ. Hiatal hernia and acid reflux frequency predict presence and length of Barrett’s esophagus. Dig Dis Sci 2002;47:256–264.PubMedCrossRefGoogle Scholar
  31. 31.
    Wakelin DE, Al-Mutawa T, Wendel C, Green C, Garewal HS, Fass R. A predictive model for length of Barrett’s esophagus with hiatal hernia length and duration of esophageal acid exposure. Gastrointest Endosc 2003;58:350–355.PubMedCrossRefGoogle Scholar
  32. 32.
    Conio M, Filiberti R, Blanchi S, Ferraris R, Marchi S, Ravelli P, et al. Risk factors for Barrett’s esophagus: a case control study. Int J Cancer 2002;97:225–229.PubMedCrossRefGoogle Scholar
  33. 33.
    Gerson LB, Shetler K, Triadafilopoulos G. Prevalence of Barrett’s esophagus in asymptomatic individuals. Gastroenterology 2002;123:461–467.PubMedCrossRefGoogle Scholar
  34. 34.
    Voutilainen M, Färkkilä M, Juhola M, Nuorva K, Mauranen K, Mäntynen T, et al. Specialized columnar epithelium of the esophagogastric junction: prevalence and associations. The Central Finland Endoscopy Study Group. Am J Gastroenterol 1999;94:913–918.PubMedCrossRefGoogle Scholar
  35. 35.
    Wilkinson SP, Biddlestone L, Gore S, Shepherd NA. Regression of columnar-lined (Barrett’s) oesophagus with omeprazole 40 mg daily: results of 5 years of continuous therapy. Aliment Pharmacol Ther 1999;13:1205–1209.PubMedCrossRefGoogle Scholar
  36. 36.
    Ouatu-Lascar R, Fitzgerald RC, Triadafilopoulos G. Differentiation and proliferation in Barrett’s esophagus and the effects of acid suppression. Gastroenterology 1999;117:327–335.PubMedCrossRefGoogle Scholar
  37. 37.
    Amano Y, Chinuki D, Yuki T, Takahashi Y, Ishimura N, Kazumori H, et al. Efficacy of proton pump inhibitors for cellular proliferation and apoptosis in Barrett’s oesophagus with different mucin phenotypes. Aliment Pharmacol Ther 2006;24Suppl 4:41–48.Google Scholar
  38. 38.
    Horwhat JD, Baroni D, Maydonovitch C, Osgard E, Ormseth E, Rueda-Pedraza E, et al. Normalization of intestinal metaplasia in the esophagus and esophagogastric junction: incidence and clinical data. Am J Gastroenterol 2007;102:497–506.PubMedCrossRefGoogle Scholar
  39. 39.
    Overholt BF. Acid suppression and reepithelialization after ablation of Barrett’s esophagus. Dig Dis 2000–2001;18:232–239.PubMedCrossRefGoogle Scholar
  40. 40.
    Biddlestone LR, Barham CP, Wilkinson SP, Barr H, Shepherd NA. The histopathology of treated Barrett’s esophagus: squamous reepithelialization after acid suppression and laser and photodynamic therapy. Am J Surg Pathol 1998;22:239–245.PubMedCrossRefGoogle Scholar
  41. 41.
    Amano Y, Kushiyama Y, Yuki T, Takahashi Y, Chinuki D, Ishimura N, et al. Predictors for squamous re-epithelialization of Barrett’s esophagus after endoscopic biopsy. J Gastroenterol Hepatol 2007:22;901–907.PubMedCrossRefGoogle Scholar
  42. 42.
    Neumann CS, Iqbal TH, Cooper BT. Long term continuous omeprazole treatment of patients with Barrett’s oesophagus. Aliment Pharmacol Ther 1995;9:451–454.PubMedCrossRefGoogle Scholar
  43. 43.
    Katsube T, Adachi K, Furuta K, Miki M, Fujisawa T, Azumi T, et al. Difference in localization of esophageal mucosal breaks among grades of esophagitis. J Gastroenterol Hepatol 2006;21:1656–1659.PubMedCrossRefGoogle Scholar
  44. 44.
    Edebo A, Vieth M, Tam W, Bruno M, van Berkel AM, Stolte M, et al. Circumferential and axial distribution of esophageal mucosal damage in reflux disease. Dis Esophagus 2007;20:232–238.PubMedCrossRefGoogle Scholar
  45. 45.
    Moriyama N, Amano Y, Okita K, Mishima Y, Ishihara S, Kinoshita Y. Localization of early stage dysplastic Barrett’s lesion in patients with short segment Barrett’s esophagus. Am J Gastroenterol 2006;101:2666–2667.PubMedGoogle Scholar
  46. 46.
    Dekel R, Wakelin DE, Wendel C, Green C, Sampliner RE, Garewal HS, et al. Progression or regression of Barrett’s esophagus—is it all in the eye of the beholder? Am J Gastroenterol 2003;98:2612–2615.PubMedGoogle Scholar
  47. 47.
    Egger K, Meining A, Werner M, Höfler H, Classen M, Rösch T. Endoscopic measurement of Barrett’s esophagus length is unreliable—a prospective comparative biopsy study. Z Gastroenterol 2004;42:499–504.PubMedCrossRefGoogle Scholar
  48. 48.
    Guda NM, Partington S, Vakil N. Inter- and intra-observer variability in the measurement of length at endoscopy: implications for the measurement of Barrett’s esophagus. Gastrointest Endosc 2004;59:655–658.PubMedCrossRefGoogle Scholar
  49. 49.
    El-Serag HB, Garewel H, Kuebeler M, Sampliner RE. Is the length of newly diagnosed Barrett’s esophagus decreasing? The experience of a VA Health Care System. Clin Gastroenterol Hepatol 2004;2:296–300.PubMedCrossRefGoogle Scholar
  50. 50.
    Amano Y, Kinoshita Y. Barrett’s esophagus: perspectives on its diagnosis and management in Asian populations. Gastroenterol Hepatol 2008;4:45–53.Google Scholar
  51. 51.
    Amano Y, Ishimura N, Furuta K, Takahashi Y, Chinuki D, Mishima Y, et al. Which landmark results in a more consistent diagnosis of Barrett’s esophagus, the gastric folds or the palisade vessels? Gastrointest Endosc 2006;64:206–211.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2008

Authors and Affiliations

  • Koichi Okita
    • 1
  • Yuji Amano
    • 2
  • Yoshiko Takahashi
    • 1
  • Yuko Mishima
    • 1
  • Nobuyuki Moriyama
    • 1
  • Norihisa Ishimura
    • 1
  • Shunji Ishihara
    • 1
  • Yoshikazu Kinoshita
    • 1
  1. 1.Department of GastroenterologyShimane University, School of MedicineIzumoJapan
  2. 2.Division of Gastrointestinal EndoscopyShimane University HospitalShimaneJapan

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