Increased Prevalence of Barrett's Esophagus in Taiwan: A Prospective Multicenter Study

doi:10.1111/jgh.16992

Multicenter Study

. 2025 Jul;40(7):1695-1702.

doi: 10.1111/jgh.16992. Epub 2025 Apr 29.

Increased Prevalence of Barrett's Esophagus in Taiwan: A Prospective Multicenter Study

Fu-Jen Lee^{1

2}, Ming-Chang Tsai^{3

4}, Chien-Lin Chen^{5

6}, Ming-Wun Wong⁵, Hsu-Heng Yen^{7

8}, Jeng-Yih Wu⁹, Chen-Shuan Chung¹⁰, Ping-Huei Tseng¹¹, Ying-Nan Tsai¹², Ming-Tsung Hsieh¹³, Chi-Yang Chang^{1

2}

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan.
² School of Medicine, Fu Jen Catholic University College of Medicine, New Taipei City, Taiwan.
³ School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁴ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
⁵ Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
⁶ Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
⁷ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁸ Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan.
⁹ Faculty of College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁰ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
¹¹ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
¹² Division of Gastroenterology and Hepatology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
¹³ Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

PMID: 40300615
PMCID: PMC12212406
DOI: 10.1111/jgh.16992

Multicenter Study

Increased Prevalence of Barrett's Esophagus in Taiwan: A Prospective Multicenter Study

Fu-Jen Lee et al. J Gastroenterol Hepatol. 2025 Jul.

. 2025 Jul;40(7):1695-1702.

doi: 10.1111/jgh.16992. Epub 2025 Apr 29.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan.
² School of Medicine, Fu Jen Catholic University College of Medicine, New Taipei City, Taiwan.
³ School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁴ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
⁵ Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
⁶ Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
⁷ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
⁸ Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan.
⁹ Faculty of College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹⁰ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
¹¹ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
¹² Division of Gastroenterology and Hepatology, E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.
¹³ Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

PMID: 40300615
PMCID: PMC12212406
DOI: 10.1111/jgh.16992

Abstract

Background and aim: With rising rates of esophageal adenocarcinoma (EAC) in Western countries, Barrett's esophagus (BE) has become a growing concern. The increasing prevalence of chronic gastroesophageal reflux disease (GERD) in Taiwan suggests a potential rise in BE cases as well. A 2007 large-scale study reported a BE prevalence of 1.06% in Taiwan. Our multicenter prospective study aims to evaluate the current prevalence of BE and identify key risk factors in this region.

Method: We assessed outpatients undergoing upper gastrointestinal endoscopy for various symptoms, obtaining biopsies from endoscopically suspected esophageal metaplasia (ESEM) at least 1 cm above the gastroesophageal junction. Quadrant biopsies were taken every 2 cm, with BE confirmed by histological evidence of specialized intestinal metaplasia.

Results: Among 8697 subjects, the prevalence of BE was 2.6%. GERD symptoms, erosive esophagitis (EE), and hiatal hernia (HH) were present in 52.5%, 27.3%, and 7.85% of subjects, respectively. Of 751 with ESEM, 228 were diagnosed with BE, predominantly short-segment BE (78.1%). Multivariate analysis identified significant risk factors for BE: age > 50 (OR = 1.59), male gender (OR = 2.27), alcohol consumption (OR = 1.70), GERD symptoms (OR = 1.45), EE (OR = 1.94), and HH (OR = 2.49) (all p < 0.01).

Conclusion: The prevalence of BE was identified as 2.6%, representing a significant increase compared with 2007. Significant risk factors include age more than 50, male gender, alcohol use, GERD symptoms, EE, and HH.

Keywords: Barrett's esophagus; gastroesophageal reflux disease; hiatal hernia; prevalence; risk factor.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

**FIGURE 1**
Flowchart for patients recruited into the study. BE = Barrett esophagus, EDG = esophagogastrodenoscopy, ESEM = endoscopically suspected esophageal metaplasia.

**FIGURE 2**
Comparison of prevalence of BE in 2007 and 2023.

See this image and copyright information in PMC

References

1. Lagergren J., Bergström R., Lindgren A., and Nyrén O., “Symptomatic Gastroesophageal Reflux as a Risk Factor for Esophageal Adenocarcinoma,” New England Journal of Medicine 340, no. 11 (1999): 825–831. - PubMed
1. Falk G. W., “Barrett's Esophagus,” Gastroenterology 122, no. 6 (2002): 1569–1591. - PubMed
1. Solaymani‐Dodaran M., Logan R. F., West J., Card T., and Coupland C., “Risk of Oesophageal Cancer in Barrett's Oesophagus and Gastro‐Oesophageal Reflux,” Gut 53, no. 8 (2004): 1070–1074. - PMC - PubMed
1. Devesa S. S., Blot W. J., and J. F. Fraumeni, Jr. , “Changing Patterns in the Incidence of Esophageal and Gastric Carcinoma in the United States,” Cancer 83, no. 10 (1998): 2049–2053. - PubMed
1. Spechler S. J. and Goyal R. K., “Barrett's Esophagus,” New England Journal of Medicine 315, no. 6 (1986): 362–371. - PubMed

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[1] Lagergren J., Bergström R., Lindgren A., and Nyrén O., “Symptomatic Gastroesophageal Reflux as a Risk Factor for Esophageal Adenocarcinoma,” New England Journal of Medicine 340, no. 11 (1999): 825–831. - PubMed

[2] Lagergren J., Bergström R., Lindgren A., and Nyrén O., “Symptomatic Gastroesophageal Reflux as a Risk Factor for Esophageal Adenocarcinoma,” New England Journal of Medicine 340, no. 11 (1999): 825–831. - PubMed

[3] Falk G. W., “Barrett's Esophagus,” Gastroenterology 122, no. 6 (2002): 1569–1591. - PubMed

[4] Falk G. W., “Barrett's Esophagus,” Gastroenterology 122, no. 6 (2002): 1569–1591. - PubMed

[5] Solaymani‐Dodaran M., Logan R. F., West J., Card T., and Coupland C., “Risk of Oesophageal Cancer in Barrett's Oesophagus and Gastro‐Oesophageal Reflux,” Gut 53, no. 8 (2004): 1070–1074. - PMC - PubMed

[6] Solaymani‐Dodaran M., Logan R. F., West J., Card T., and Coupland C., “Risk of Oesophageal Cancer in Barrett's Oesophagus and Gastro‐Oesophageal Reflux,” Gut 53, no. 8 (2004): 1070–1074. - PMC - PubMed

[7] Devesa S. S., Blot W. J., and J. F. Fraumeni, Jr. , “Changing Patterns in the Incidence of Esophageal and Gastric Carcinoma in the United States,” Cancer 83, no. 10 (1998): 2049–2053. - PubMed

[8] Devesa S. S., Blot W. J., and J. F. Fraumeni, Jr. , “Changing Patterns in the Incidence of Esophageal and Gastric Carcinoma in the United States,” Cancer 83, no. 10 (1998): 2049–2053. - PubMed

[9] Spechler S. J. and Goyal R. K., “Barrett's Esophagus,” New England Journal of Medicine 315, no. 6 (1986): 362–371. - PubMed

[10] Spechler S. J. and Goyal R. K., “Barrett's Esophagus,” New England Journal of Medicine 315, no. 6 (1986): 362–371. - PubMed

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Increased Prevalence of Barrett's Esophagus in Taiwan: A Prospective Multicenter Study

Affiliations

Increased Prevalence of Barrett's Esophagus in Taiwan: A Prospective Multicenter Study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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References

Publication types

MeSH terms

Grants and funding

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Abstract

Conflict of interest statement

Figures

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References

Publication types

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Related information

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