Clin Endosc.  2014 Jan;47(1):15-22.

Barrett Esophagus in Asia: Same Disease with Different Pattern

• Lee HS
• Jeon SW

Abstract

Barrett esophagus (BE) is considered to develop as a result of chronic gastroesophageal reflux disease (GERD) and to predispose to esophageal adenocarcinoma (EAC). However, the disease pattern of BE in Asia differs from that observed in the West. For example, in the West, the prevalence rates of BE and EAC have progressively increased, whereas although the prevalence rate of GERD is increasing in Asia, the prevalence rates of BE and EAC have remained low in most Asian countries. GERD, hiatal hernia, old age, male sex, abdominal obesity (visceral obesity), smoking, alcohol consumption, and kyphosis are known risk factors for BE in Asia, and most Asian patients have short-segment BE. Helicobacter pylori infection is more prevalent in Asia than in the West. We suggest larger studies with a prospective design be conducted to elaborate further the different patterns of BE in Asia.

Keyword

Barrett esophagus; Prevalence; Risk factors

MeSH Terms

Adenocarcinoma
Alcohol Drinking
Asia*
Asian Continental Ancestry Group
Barrett Esophagus*
Gastroesophageal Reflux
Helicobacter pylori
Hernia, Hiatal
Humans
Kyphosis
Male
Obesity, Abdominal
Prevalence
Risk Factors
Smoke
Smoking
Smoke

Figure

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  Fig. 1 Prevalence of Barrett esophagus in Asia.

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  Fig. 2 The Prague classification of Barrett esophagus. The Prague C&M classification uses the C value for the circumferential pattern (C) and the M value for the maximum length (M) (including tongue-like pattern).

Reference

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. PMID: 15236196.

2. Wang KK, Sampliner RE. Practice Parameters Committee of the American College of Gastroenterology. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol. 2008; 103:788–797. PMID: 18341497.

3. Lieberman DA, Oehlke M, Helfand M. Gastroenterology Outcomes Research Group in Endoscopy. Risk factors for Barrett's esophagus in community-based practice. GORGE consortium. Am J Gastroenterol. 1997; 92:1293–1297. PMID: 9260792.

4. Hameeteman W, Tytgat GN, Houthoff HJ, van den Tweel JG. Barrett's esophagus: development of dysplasia and adenocarcinoma. Gastroenterology. 1989; 96(5 Pt 1):1249–1256. PMID: 2703113.

5. Shaheen NJ, Richter JE. Barrett's oesophagus. Lancet. 2009; 373:850–861. PMID: 19269522.

6. Hongo M, Nagasaki Y, Shoji T. Epidemiology of esophageal cancer: Orient to Occident. Effects of chronology, geography and ethnicity. J Gastroenterol Hepatol. 2009; 24:729–735. PMID: 19646015.

7. Ho KY, Cheung TK, Wong BC. Gastroesophageal reflux disease in Asian countries: disorder of nature or nurture? J Gastroenterol Hepatol. 2006; 21:1362–1365. PMID: 16911677.

8. 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. PMID: 10955596.

9. Chen X, Zhu LR, Hou XH. The characteristics of Barrett's esophagus: an analysis of 4120 cases in China. Dis Esophagus. 2009; 22:348–353. PMID: 19191861.

10. Chang CY, Cook MB, Lee YC, et al. Current status of Barrett's esophagus research in Asia. J Gastroenterol Hepatol. 2011; 26:240–246. PMID: 21155883.

11. Corley DA, Kubo A, Levin TR, et al. Race, ethnicity, sex and temporal differences in Barrett's oesophagus diagnosis: a large community-based study, 1994-2006. Gut. 2009; 58:182–188. PMID: 18978173.

12. Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA. 1991; 265:1287–1289. PMID: 1995976.

13. Chak A, Faulx A, Eng C, et al. Gastroesophageal reflux symptoms in patients with adenocarcinoma of the esophagus or cardia. Cancer. 2006; 107:2160–2166. PMID: 17019737.

14. Shaheen N, Ransohoff DF. Gastroesophageal reflux, barrett esophagus, and esophageal cancer: scientific review. JAMA. 2002; 287:1972–1981. PMID: 11960540.

15. Ronkainen J, Aro P, Storskrubb T, et al. Prevalence of Barrett's esophagus in the general population: an endoscopic study. Gastroenterology. 2005; 129:1825–1831. PMID: 16344051.

16. Rex DK, Cummings OW, Shaw M, et al. Screening for Barrett's esophagus in colonoscopy patients with and without heartburn. Gastroenterology. 2003; 125:1670–1677. PMID: 14724819.

17. Hayeck TJ, Kong CY, Spechler SJ, Gazelle GS, Hur C. The prevalence of Barrett's esophagus in the US: estimates from a simulation model confirmed by SEER data. Dis Esophagus. 2010; 23:451–457. PMID: 20353441.

18. Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut. 2005; 54:710–717. PMID: 15831922.

19. Fock KM, Ang TL. Global epidemiology of Barrett's esophagus. Expert Rev Gastroenterol Hepatol. 2011; 5:123–130. PMID: 21309677.

20. Choi CY, Suh S, Park JS, et al. The prevalence of Barrett's esophagus and the comparison of Barrett's esophagus with cardiac intestinal metaplasia in the health screening at a secondary care hospital. Korean J Gastroenterol. 2012; 60:219–223. PMID: 23089907.

21. Xiong LS, Cui Y, Wang JP, et al. Prevalence and risk factors of Barrett's esophagus in patients undergoing endoscopy for upper gastrointestinal symptoms. J Dig Dis. 2010; 11:83–87. PMID: 20402833.

22. Yeh C, Hsu CT, Ho AS, Sampliner RE, Fass R. Erosive esophagitis and Barrett's esophagus in Taiwan: a higher frequency than expected. Dig Dis Sci. 1997; 42:702–706. PMID: 9125635.

23. Zhang M, Fan XS, Zou XP. The prevalence of Barrett's esophagus remains low in Eastern China. Single-center 7-year descriptive study. Saudi Med J. 2012; 33:1324–1329. PMID: 23232681.

24. Peng S, Cui Y, Xiao YL, et al. Prevalence of erosive esophagitis and Barrett's esophagus in the adult Chinese population. Endoscopy. 2009; 41:1011–1017. PMID: 19967617.

25. Amano Y, Kushiyama Y, Yuki T, et al. Prevalence of and risk factors for Barrett's esophagus with intestinal predominant mucin phenotype. Scand J Gastroenterol. 2006; 41:873–879. PMID: 16803684.

26. Akiyama T, Inamori M, Akimoto K, et al. Risk factors for the progression of endoscopic Barrett's epithelium in Japan: a multivariate analysis based on the Prague C & M Criteria. Dig Dis Sci. 2009; 54:1702–1707. PMID: 19003532.

27. Okita K, Amano Y, Takahashi Y, et al. Barrett's esophagus in Japanese patients: its prevalence, form, and elongation. J Gastroenterol. 2008; 43:928–934. PMID: 19107336.

28. Lee IS, Choi SC, Shim KN, et al. Prevalence of Barrett's esophagus remains low in the Korean population: nationwide cross-sectional prospective multicenter study. Dig Dis Sci. 2010; 55:1932–1939. PMID: 19798574.

29. Kim JH, Rhee PL, Lee JH, et al. Prevalence and risk factors of Barrett's esophagus in Korea. J Gastroenterol Hepatol. 2007; 22:908–912. PMID: 17565647.

30. Dhawan PS, Alvares JF, Vora IM, et al. Prevalence of short segments of specialized columnar epithelium in distal esophagus: association with gastroesophageal reflux. Indian J Gastroenterol. 2001; 20:144–147. PMID: 11497172.

31. Rosaida MS, Goh KL. Gastro-oesophageal reflux disease, reflux oesophagitis and non-erosive reflux disease in a multiracial Asian population: a prospective, endoscopy based study. Eur J Gastroenterol Hepatol. 2004; 16:495–501. PMID: 15097043.

32. Odemiş B, Ciçek B, Zengin NI, et al. Barrett's esophagus and endoscopically assessed esophagogastric junction integrity in 1000 consecutive Turkish patients undergoing endoscopy: a prospective study. Dis Esophagus. 2009; 22:649–655. PMID: 19515192.

33. 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. PMID: 19098843.

34. Khamechian T, Alizargar J, Mazoochi T. The prevalence of Barrett's esophagus in outpatients with dyspepsia in Shaheed Beheshti Hospital of Kashan. Iran J Med Sci. 2013; 38:263–266. PMID: 24174698.

35. Amano Y, Ishimura N, Furuta K, 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. PMID: 16860070.

36. Choi DW, Oh SN, Baek SJ, et al. Endoscopically observed lower esophageal capillary patterns. Korean J Intern Med. 2002; 17:245–248. PMID: 12647639.

37. Kuo CJ, Lin CH, Liu NJ, Wu RC, Tang JH, Cheng CL. Frequency and risk factors for Barrett's esophagus in Taiwanese patients: a prospective study in a tertiary referral center. Dig Dis Sci. 2010; 55:1337–1343. PMID: 19557516.

38. Fujiwara Y, Higuchi K, Shiba M, et al. Association between gastroesophageal flap valve, reflux esophagitis, Barrett's epithelium, and atrophic gastritis assessed by endoscopy in Japanese patients. J Gastroenterol. 2003; 38:533–539. PMID: 12825128.

39. Park JJ, Kim JW, Kim HJ, et al. The prevalence of and risk factors for Barrett's esophagus in a Korean population: a nationwide multicenter prospective study. J Clin Gastroenterol. 2009; 43:907–914. PMID: 19417682.

40. Tseng PH, Lee YC, Chiu HM, et al. Prevalence and clinical characteristics of Barrett's esophagus in a Chinese general population. J Clin Gastroenterol. 2008; 42:1074–1079. PMID: 18360296.

41. Rajendra S, Kutty K, Karim N. Ethnic differences in the prevalence of endoscopic esophagitis and Barrett's esophagus: the long and short of it all. Dig Dis Sci. 2004; 49:237–242. PMID: 15104363.

42. Takubo K, Vieth M, Aida J, et al. Differences in the definitions used for esophageal and gastric diseases in different countries: endoscopic definition of the esophagogastric junction, the precursor of Barrett's adenocarcinoma, the definition of Barrett's esophagus, and histologic criteria for mucosal adenocarcinoma or high-grade dysplasia. Digestion. 2009; 80:248–257. PMID: 19828957.

43. Ho KY. From GERD to Barrett's esophagus: is the pattern in Asia mirroring that in the West? J Gastroenterol Hepatol. 2011; 26:816–824. PMID: 21265879.

44. Lee YC, Cook MB, Bhatia S, et al. Interobserver reliability in the endoscopic diagnosis and grading of Barrett's esophagus: an Asian multinational study. Endoscopy. 2010; 42:699–704. PMID: 20806154.

45. Sharma P, Dent J, Armstrong D, 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. PMID: 17101315.

46. Spechler SJ. Short and ultrashort Barrett's esophagus: what does it mean? Semin Gastrointest Dis. 1997; 8:59–67. PMID: 9109693.

47. Derakhshan MH, Malekzadeh R, Watabe H, et al. Combination of gastric atrophy, reflux symptoms and histological subtype indicates two distinct aetiologies of gastric cardia cancer. Gut. 2008; 57:298–305. PMID: 17965056.

48. Parfitt JR, Miladinovic Z, Driman DK. Increasing incidence of adenocarcinoma of the gastroesophageal junction and distal stomach in Canada: an epidemiological study from 1964-2002. Can J Gastroenterol. 2006; 20:271–276. PMID: 16609756.

49. Lagergren J. Adenocarcinoma of oesophagus: what exactly is the size of the problem and who is at risk? Gut. 2005; 54(Suppl 1):i1–i5. PMID: 15711002.

50. Yousef F, Cardwell C, Cantwell MM, Galway K, Johnston BT, Murray L. The incidence of esophageal cancer and high-grade dysplasia in Barrett's esophagus: a systematic review and meta-analysis. Am J Epidemiol. 2008; 168:237–249. PMID: 18550563.

51. Miyazaki T, Inose T, Tanaka N, et al. Management of Barrett's esophageal carcinoma. Surg Today. 2013; 43:353–360. PMID: 23283352.

52. Committee for Scientific Affairs. Sakata R, Fujii Y, Kuwano H. Thoracic and cardiovascular surgery in Japan during 2009: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2011; 59:636–667. PMID: 22231795.

53. Kazui T, Wada H, Fujita H. Japanese Association for Thoracic Surgery Committee of Science. Thoracic and cardiovascular surgery in Japan during 2003: annual report by The Japanese Association for Thoracic Surgery. Jpn J Thorac Cardiovasc Surg. 2005; 53:517–536. PMID: 16200897.

54. Fernandes ML, Seow A, Chan YH, Ho KY. Opposing trends in incidence of esophageal squamous cell carcinoma and adenocarcinoma in a multi-ethnic Asian country. Am J Gastroenterol. 2006; 101:1430–1436. PMID: 16863543.

55. 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; 22:676–681. PMID: 19222529.

56. Yee YK, Cheung TK, Chan AO, Yuen MF, Wong BC. Decreasing trend of esophageal adenocarcinoma in Hong Kong. Cancer Epidemiol Biomarkers Prev. 2007; 16:2637–2640. PMID: 18086768.

57. Streitz JM Jr, Ellis FH Jr, Tilden RL, Erickson RV. Endoscopic surveillance of Barrett's esophagus: a cost-effectiveness comparison with mammographic surveillance for breast cancer. Am J Gastroenterol. 1998; 93:911–915. PMID: 9647017.

58. Provenzale D, Schmitt C, Wong JB. Barrett's esophagus: a new look at surveillance based on emerging estimates of cancer risk. Am J Gastroenterol. 1999; 94:2043–2053. PMID: 10445526.

59. Neumann CS, Cooper BT. 24 hour ambulatory oesophageal pH monitoring in uncomplicated Barrett's oesophagus. Gut. 1994; 35:1352–1355. PMID: 7959184.

60. Oberg S, DeMeester TR, Peters JH, et al. The extent of Barrett's esophagus depends on the status of the lower esophageal sphincter and the degree of esophageal acid exposure. J Thorac Cardiovasc Surg. 1999; 117:572–580. PMID: 10047662.

61. Singh P, Taylor RH, Colin-Jones DG. Esophageal motor dysfunction and acid exposure in reflux esophagitis are more severe if Barrett's metaplasia is present. Am J Gastroenterol. 1994; 89:349–356. PMID: 8122643.

62. Cameron AJ. Barrett's esophagus: prevalence and size of hiatal hernia. Am J Gastroenterol. 1999; 94:2054–2059. PMID: 10445527.

63. Rajendra S, Ackroyd R, Robertson IK, Ho JJ, Karim N, Kutty KM. Helicobacter pylori, ethnicity, and the gastroesophageal reflux disease spectrum: a study from the East. Helicobacter. 2007; 12:177–183. PMID: 17309756.

64. Hirschowitz BI. Gastric acid and pepsin secretion in patients with Barrett's esophagus and appropriate controls. Dig Dis Sci. 1996; 41:1384–1391. PMID: 8689915.

65. Champion G, Richter JE, Vaezi MF, Singh S, Alexander R. Duodenogastroesophageal reflux: relationship to pH and importance in Barrett's esophagus. Gastroenterology. 1994; 107:747–754. PMID: 8076761.

66. Vaezi MF, Richter JE. Role of acid and duodenogastroesophageal reflux in gastroesophageal reflux disease. Gastroenterology. 1996; 111:1192–1199. PMID: 8898632.

67. Raghunath A, Hungin AP, Wooff D, Childs S. Prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease: systematic review. BMJ. 2003; 326:737. PMID: 12676842.

68. Abe Y, Iijima K, Koike T, et al. Barrett's esophagus is characterized by the absence of Helicobacter pylori infection and high levels of serum pepsinogen I concentration in Japan. J Gastroenterol Hepatol. 2009; 24:129–134. PMID: 19196398.

69. Hongo M. Review article: Barrett's oesophagus and carcinoma in Japan. Aliment Pharmacol Ther. 2004; 20(Suppl 8):50–54. PMID: 15575874.

70. Seidel D, Muangpaisan W, Hiro H, Mathew A, Lyratzopoulos G. The association between body mass index and Barrett's esophagus: a systematic review. Dis Esophagus. 2009; 22:564–570. PMID: 19392850.

71. Akiyama T, Yoneda M, Inamori M, et al. Visceral obesity and the risk of Barrett's esophagus in Japanese patients with non-alcoholic fatty liver disease. BMC Gastroenterol. 2009; 9:56. PMID: 19622165.

72. Akiyama T, Yoneda M, Maeda S, Nakajima A, Koyama S, Inamori M. Visceral obesity and the risk of Barrett's esophagus. Digestion. 2011; 83:142–145. PMID: 21266807.

73. Weinsier RL, Hunter GR, Gower BA, Schutz Y, Darnell BE, Zuckerman PA. Body fat distribution in white and black women: different patterns of intraabdominal and subcutaneous abdominal adipose tissue utilization with weight loss. Am J Clin Nutr. 2001; 74:631–636. PMID: 11684531.

74. Akiyama T, Inamori M, Iida H, et al. Alcohol consumption is associated with an increased risk of erosive esophagitis and Barrett's epithelium in Japanese men. BMC Gastroenterol. 2008; 8:58. PMID: 19077221.

75. Lee SJ, Jung MK, Kim SK, et al. Clinical characteristics of gastroesophageal reflux disease with esophageal injury in korean: focusing on risk factors. Korean J Gastroenterol. 2011; 57:281–287. PMID: 21623136.

76. Caygill CP, Johnston DA, Lopez M, et al. Lifestyle factors and Barrett's esophagus. Am J Gastroenterol. 2002; 97:1328–1331. PMID: 12094845.

77. Uno G, Amano Y, Yuki T, et al. Relationship between kyphosis and Barrett's esophagus in Japanese patients. Intern Med. 2011; 50:2725–2730. PMID: 22082882.

78. Manabe N, Haruma K, Imamura H, et al. Does short-segment columnar-lined esophagus elongate during a mean follow-up period of 5.7 years? Dig Endosc. 2011; 23:166–172. PMID: 21429023.

79. Huang Q, Fang DC, Fang JY, et al. How to diagnose and manage patients with Barrett's esophagus in China. J Dig Dis. 2012; 13:123–132. PMID: 22356307.

80. Goda K, Singh R, Oda I, et al. Current status of endoscopic diagnosis and treatment of superficial Barrett's adenocarcinoma in Asia-Pacific region. Dig Endosc. 2013; 25(Suppl 2):146–150. PMID: 23617667.