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Meta-Analysis
. 2022 Aug;37(8):1507-1516.
doi: 10.1111/jgh.15902. Epub 2022 Jun 2.

Effect of gastro-esophageal reflux symptoms on the risk of Barrett's esophagus: A systematic review and meta-analysis

Leonardo H Eusebi  1   2 , Andrea Telese  3 , Giovanna G Cirota  1   2 , Rehan Haidry  3 , R Maurizio Zagari  1   2 , Franco Bazzoli  1   2 , Alexander C Ford  4   5
Affiliations
Meta-Analysis

Effect of gastro-esophageal reflux symptoms on the risk of Barrett's esophagus: A systematic review and meta-analysis

Leonardo H Eusebi et al. J Gastroenterol Hepatol. 2022 Aug.

Abstract

Background and aim: Gastro-esophageal reflux (GER) is the main predisposing factor for Barrett's esophagus (BE). A more precise estimate of the association of GER symptoms with the risk of BE would be important to prioritize endoscopic screening. We conducted a systematic review and meta-analysis to examine this issue.

Methods: MEDLINE, EMBASE, and EMBASE Classic were searched to identify cross-sectional studies that reported the prevalence of BE based on presence of GER symptoms. The prevalence of BE was compared according to presence or absence of GER symptoms using an odds ratio (OR), with a 95% confidence interval (CI). Specificity and sensitivity of GER symptoms for predicting BE was calculated.

Results: Of 10,463 citations evaluated, 19 studies reported the prevalence of BE in 43,017 subjects. The pooled OR among individuals with weekly GER symptoms compared with those without was 1.67 (95% CI 1.30-2.15) for endoscopically suspected BE, and 2.42 (95% CI 1.59-3.68) for histologically confirmed BE. No significant association was found between weekly GER symptoms and the presence of short segment BE (OR 1.30; 95% CI 0.86-1.97), whereas a strong association was present with long segment BE, with an OR of 6.30 (95% CI 2.26-17.61).

Conclusions: Gastro-esophageal reflux symptoms are associated with an increased odds of BE, with a further increase when weekly symptoms are present. Overall, GER symptoms showed low sensitivity and specificity for predicting BE; however, a strong association was found between weekly GER symptoms and long segment BE, but not short segment BE, suggesting that it may be worth considering screening individuals with weekly GER symptoms to rule out long segment BE.

Keywords: Barrett's esophagus; epidemiology; esophageal cancer; gastro-esophageal reflux disease.

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Figures

Figure 1
Figure 1
Flow diagram of studies identified in the systematic review.
Figure 2
Figure 2
Odds ratio for endoscopically suspected Barrett's esophagus in individuals with gastro‐esophageal reflux symptoms of any frequency compared with those without.
Figure 3
Figure 3
Odds ratio for endoscopically suspected Barrett's esophagus in individuals with gastro‐esophageal reflux disease compared with those without.
Figure 4
Figure 4
Odds ratio for histologically confirmed Barrett's esophagus in individuals with gastro‐esophageal reflux symptoms of any frequency compared with those without.
Figure 5
Figure 5
Odds ratio for histologically confirmed Barrett's esophagus in individuals with gastro‐esophageal reflux disease compared with those without.
See this image and copyright information in PMC

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