Advertisement

Digestive Diseases and Sciences

, Volume 55, Issue 7, pp 1932–1939 | Cite as

Prevalence of Barrett’s Esophagus Remains Low in the Korean Population: Nationwide Cross-Sectional Prospective Multicenter Study

  • In Seok Lee
  • Suck Chei ChoiEmail author
  • Ki Nam Shim
  • Sam Ryong Jee
  • Kyu Chan Huh
  • Jun Haeng Lee
  • Kwang Jae Lee
  • Hyung Seok Park
  • Yong Chan Lee
  • Hoon Yong Jung
  • Hyo Jin Park
Original Article

Abstract

Purpose

In contrast to the Western population, the prevalence of Barrett’s esophagus (BE) is rare in the Korean population. However, the recent increase in prevalence of gastroesophageal reflux disease (GERD) may affect the prevalence of BE. The aim of this study was to survey the prevalence of BE and evaluate its risk factors.

Methods

Patients between 18 and 75 years of age who visited 11 Korean tertiary referral centers between April and July 2006 for routine upper endoscopic examination were surveyed using a symptom questionnaire. Biopsies were performed on the columnar lined epithelium (CLE) of the distal esophagus, and diagnosis was confirmed with detection of specialized intestinal metaplasia.

Results

The study comprised 2,048 patients (mean age 51.4 years, 965 males). The frequency of heartburn or acid regurgitation was 8.7% and 13.1%, respectively. Reflux esophagitis was diagnosed in 10.1% of patients (207 patients); however, most patients had mild reflux. CLE was found in 82 patients; however, only one patient had long-segment CLE. The prevalence of BE was 1% (21 patients). The risk factors for BE were age (P = 0.006), presence of heartburn [odds ratio (OR) 4.33, 95% confidence interval (CI) 1.66–11.34, P = 0.007], acid regurgitation (OR 3.37, 95% CI 1.35–8.42, P = 0.01), sliding hernia (OR 6.21, 95% CI 1.78–21.72, P = 0.001), and reflux esophagitis (OR 10.28, 95% CI 4.31–24.50, P < 0.0001) on univariate analysis. On multivariate analysis, presence of typical reflux symptoms (P = 0.02) and reflux esophagitis (P < 0.001) were significant.

Conclusions

Prevalence of Barrett’s esophagus remains low in Koreans; however, risk of developing BE has increased in patients with GERD symptoms and reflux esophagitis.

Keywords

Prevalence Barrett’s esophagus Korean Gastroesophageal reflux Reflux esophagitis 

Notes

Acknowledgments

We thank Eunyoung Kim for data management. This work was funded by grants from The Korean Society of Neurogastroenterology and Motility Jeil Pharm. Co., SK Pharm. Co., and Astra Zeneca Pharm. Co.

References

  1. 1.
    Sharma P, McQuaid K, Dent J, et al. A critical review of the diagnosis and management of Barrett’s esophagus: The AGA Chicago workshop. Gastroenterology. 2004;127:310–330.CrossRefPubMedGoogle Scholar
  2. 2.
    Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA. 1991;265:1287–1289.CrossRefPubMedGoogle Scholar
  3. 3.
    Tuyns AJ. Esophageal cancer in France and Switzerland: recent time trends. Eur J Cancer Prev. 1992;1:275–278.CrossRefPubMedGoogle Scholar
  4. 4.
    Johnston MH, Hammond AS, Laskin W, Jones DM. The prevalence and clinical characteristics of short segments of specialized intestinal metaplasia in the distal esophagus on routine endoscopy. Am J Gastroenterol. 1996;91:1507–1511.PubMedGoogle Scholar
  5. 5.
    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.CrossRefPubMedGoogle Scholar
  6. 6.
    Spechler SJ, Zeroogian JM, Antonioli DA, Wang HH, Goyal RK. Prevalence of metaplasia at the gastro-esophageal junction. Lancet. 1994;344:1533–1536.CrossRefPubMedGoogle Scholar
  7. 7.
    Weston AP, Krmpotich P, Makdisi WF, et al. Short segment Barrett’s esophagus: clinical and histological features, associated endoscopic findings, and association with gastric intestinal metaplasia. Am J Gastroenterol. 1996;91:981–986.PubMedGoogle Scholar
  8. 8.
    Cameron AJ. Epidemiology of columnar lined esophagus and adenocarcinoma. Gastroenterol Clin N Am. 1997;26:487–494.CrossRefPubMedGoogle Scholar
  9. 9.
    Ronkainen J, Aro P, Storskrubb T. Prevalence of Barrett’s esophagus in the general population: an endoscopic study. Gastroenterology. 2005;129:1825–1831.CrossRefPubMedGoogle Scholar
  10. 10.
    Rex DK, Cummings OW, Shaw M. Screening for Barrett’s esophagus in colonoscopy patients with and without heartburn. Gastroenterology. 2003;125:1670–1677.CrossRefPubMedGoogle Scholar
  11. 11.
    Ho KY, Cheung TK, Wong BC. Gastroesophageal reflux disease in Asian countries: disorder of nature or nurture. J Gastroenterol Hepatol. 2006;21:1362–1365.CrossRefPubMedGoogle Scholar
  12. 12.
    Hongo M. Review article: Barrett’s esophagus and carcinoma in Japan. Aliment Pharmacol Ther. 2004;20(s8):50–54.CrossRefPubMedGoogle Scholar
  13. 13.
    Nah YH, Jang MK, Ryu JK, Song SR. Incidence of esophagitis in gastroesophageal reflux disease (GERD). Korean J Gastroenterol. 1994;14:145–150.Google Scholar
  14. 14.
    Youn YH, Kang YW, Ahn SH, Park SK. Prevalence of alteration of reflux esophagitis. Korean J Gastrointest Endosc. 2001;23:144–148.Google Scholar
  15. 15.
    Cho YS, Choi MG, Jeong JJ, et al. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Asan-si, Korea. Am J Gastroenterol. 2005;100:747–753.CrossRefPubMedGoogle Scholar
  16. 16.
    Velanovich V, Vallance SR, Gusz JR, Tapia FV, Harkabus MA. Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg. 1996;183:217–224.PubMedGoogle Scholar
  17. 17.
    Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of esophagitis: clinical and functional correlates and further validation of the Los Angeles classification. 1999;45:172–180.Google Scholar
  18. 18.
    Kim N, Lee SW, Cho SI, et al. The prevalence of and risk factors for erosive esophagitis and non-erosive reflux disease: a nationwide multicenter prospective study in Korea. Aliment Pharmacol Ther. 2008;27:173–185.PubMedCrossRefGoogle Scholar
  19. 19.
    Son JI, Park HJ, Song KS, et al. A single center’s 30 year experience of esophageal adenocarcinoma. Kor J Int Med. 2001;16:250–253.Google Scholar
  20. 20.
    Chung JW, Lee GH, Choi KS, et al. Unchanging trend of esophagogastric junction adenocarcinoma in Korea: experience at a single institution based on Siewert’s classification. Dis Esophagus 2009; Feb 13 [Epub ahead of print].Google Scholar
  21. 21.
    Lim SB, Han SW, Lee MH. Is Barrett esophagus a rare disorder in Korea? Kor J Int Med. 1983;26:570–575.Google Scholar
  22. 22.
    Lee JI, Park HJ, Jung HY, Rhee PL, Song CW, Choi MG. Prevalence of Barrett’s esophagus in an urban Korean population: a multicenter study. J Gastroenterol. 2003;38:23–27.CrossRefPubMedGoogle Scholar
  23. 23.
    Kim JY, Kim YS, Jung MK, et al. Prevalence of Barrett’s esophagus in Korea. J Gastroenterol Hepatol. 2005;20:633–636.CrossRefPubMedGoogle Scholar
  24. 24.
    Kim JH, Rhee PL, Lee JH, et al. Prevalence and risk factors of Barrett’s esophagus in Korea. Gastroenterol Hepatol. 2007;22:908–912.CrossRefGoogle Scholar
  25. 25.
    Yeh C, Hsu CT, Ho AS, Sampliner RE, Fass R. Erosive esophagitis and Barrett’s esophagus in Taiwan. Dig Dis Sci. 1997;42:702–706.CrossRefPubMedGoogle Scholar
  26. 26.
    Rosaida MS, Goh KL. Gastro-esophageal reflux disease, reflux esophagitis and non-erosive reflux disease in a multiracial Asian population: a prospective, endoscopy based study. Eur J Gastroenterol Hepatol. 2004;16:495–501.CrossRefPubMedGoogle Scholar
  27. 27.
    Azuma N, Endo T, Arimura Y, et al. Prevalence of Barrett’s esophagus and expression of mucin antigens detected by a panel of monoclonal antibodies in Barrett’s esophagus and esophageal adenocarcinoma in Japan. J Gastroenterol. 2000;35:583–592.CrossRefPubMedGoogle Scholar
  28. 28.
    Gadour MO, Ayoola EA. Barrett’s esophagus and esophageal cancer in Saudi Arabia. Trop Gastroenterol. 1999;20:111–115.PubMedGoogle Scholar
  29. 29.
    Chang CY, Lee YC, Lee CT, et al. The application of Prague C and M criteria in the diagnosis of Barrett’s esophagus in an ethnic Chinese population. Am J Gastroenterol. 2009;104:13–20.CrossRefPubMedGoogle Scholar
  30. 30.
    Kang JY. Systematic review: geographical and ethnic differences in gastroesophageal reflux disease. Aliment Ther Pharm. 2004;20:705–717.CrossRefGoogle Scholar
  31. 31.
    Fan X, Snyder N. Prevalence of Barrett’s esophagus in patients with or without GERD symptoms: role of race, age and gender. Dig Dis Sci. 2008;54:572–577.CrossRefPubMedGoogle Scholar
  32. 32.
    Lam KD, Phan JT, Gracia RT, et al. Low proportion of Barrett’s esophagus in Asian Americans. Am J Gastroenterol. 2008;103:1625–1630.CrossRefPubMedGoogle Scholar
  33. 33.
    Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastroesophageal reflux as a risk factor esophageal adenocarcinoma. N Engl J Med. 1999;340:825–831.CrossRefPubMedGoogle Scholar
  34. 34.
    Buttar NS, Falk GW. Pathogenesis of gastroesophageal reflux and Barrett esophagus. Mayo Clin Proc. 2001;76:226–234.CrossRefPubMedGoogle Scholar
  35. 35.
    Yang SY, Lee OY, Bak YT, et al. Prevalence of gastroesophageal reflux disease symptoms and uninvestigated dyspepsia in Korea: a population-based study. Dig Dis Sci. 2008;53:188–193.CrossRefPubMedGoogle Scholar
  36. 36.
    Liebermann DA, Oehlke M, Helfand M, The GORGE Consortium. Risk factors for Barrett’s esophagus in community-based practice. Am J Gastroenterol. 1997;92:1293–1297.Google Scholar
  37. 37.
    Conio M, Filiberti R, Blanchi S, et al. Risk factors for Barrett’s esophagus: a case–control study. Int J Cancer. 2002;97:225–229.CrossRefPubMedGoogle Scholar
  38. 38.
    Choi H, Choi MG, Kim SW, et al. Functional gastrointestinal disorders in patients with gastrointestinal symptoms. Kor J Gastroenterol. 1999;33:741–748.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • In Seok Lee
    • 1
  • Suck Chei Choi
    • 2
    Email author
  • Ki Nam Shim
    • 3
  • Sam Ryong Jee
    • 4
  • Kyu Chan Huh
    • 5
  • Jun Haeng Lee
    • 6
  • Kwang Jae Lee
    • 7
  • Hyung Seok Park
    • 8
  • Yong Chan Lee
    • 9
  • Hoon Yong Jung
    • 10
  • Hyo Jin Park
    • 11
  1. 1.Department of Internal MedicineThe Catholic University of Korea College of MedicineSeoulKorea
  2. 2.Department of Internal Medicine, Digestive Disease Research InstituteWonkwang University College of MedicineChunbukKorea
  3. 3.Department of Internal MedicineEwha Womans University School of MedicineSeoulKorea
  4. 4.Department of Internal MedicineInje University College of MedicineBusanKorea
  5. 5.Department of Internal MedicineKonyang University School of MedicineDaejunKorea
  6. 6.Department of Internal MedicineSungkyunkwan University School of MedicineSeoulKorea
  7. 7.Department of Internal MedicineAjou University School of MedicineSuwonKorea
  8. 8.Department of Internal MedicineKonkuk University School of MedicineSeoulKorea
  9. 9.Department of Internal MedicineYonsei University College of MedicineSeoulKorea
  10. 10.Department of Internal MedicineUlsan University College of MedicineSeoulKorea
  11. 11.Department of Internal MedicineYonsei University College of MedicineSeoulKorea

Personalised recommendations