Barrett esophagus: perspectives on its diagnosis and management in asian populations

Abstract

Barrett esophageal cancer has the fastest growing incidence of any cancer in Western countries. In Asian countries, most cases of esophageal cancer consist of squamous cell carcinomas, not adenocarcinomas. Recently, however, the increase in the number of Barrett esophagus cases with subsequent Barrett cancer has become worrisome in Asian countries, as the number of patients with gastro-esophageal reflux disease has been increasing in these countries. In this review, recent reports regarding Barrett esophagus in Asian countries have been collected and this problem is discussed from various perspectives. In Asia, long-segment Barrett esophagus is much less prevalent than in Western countries, whereas short-segment Barrett esophagus is frequently found. In epidemiologic studies, evaluation of the prevalence of Barrett esophagus is limited by poor interob-server diagnostic agreement. Standard criteria for the endoscopic diagnosis of Barrett esophagus in Asian patients, especially of the short-segment type, should be established as soon as possible. A high prevalence of hiatal hernia and a decreasing prevalence of Helico-bacter pylori infection may increase the number of Barrett esophagus cases and subsequent Barrett cancer in Asian countries in the near future. Therefore, a strategy for the clinical management of Barrett esophagus in Asian countries should be devised.

Keywords: Asian population; Barrett esophagus; Helicobacter pylori infection; endoscopic diagnosis.

Figure 1

The prevalence of patients with Barrett esophagus (indicated by the bars) and hiatal hernia (indicated by the black dots) correlates with increasing age. During the study period of 2004– 2006, 333 patients with histologically confirmed Barrett esophagus were found in 1,997 patients who underwent eso-phagogastroduodenoscopy. In patients over 70 years of age, the prevalence of Barrett esophagus and hiatal hernia was higher than that in the younger population. *P<.05, compared to the patients younger than 40 years of age.