Epidemiology of Barrett's Esophagus and Esophageal Adenocarcinoma. Issue 1 (March 2023) - Holmberg, Dag
Background: Barrett's esophagus (BE) can progress to esophageal adenocarcinoma (EAC), a tumor characterized by rapidly increasing incidence and poor survival. We describe patterns of occurrence and risk factors for BE and EAC and how they may influence healthcare. Methods: We searched PubMed and Cochrane databases for English-language publications using the search terms Barrett's esophagus and esophageal adenocarcinoma. We mainly considered systematic reviews with meta-analysis, randomized clinical trials, population-based observational studies, and international clinical guidelines. The results were synthesized into a narrative review. Results: The prevalence of BE (currently approximately 1% among adults) and incidence of EAC (current global age-standardized incidence rate of 0.9/100 000 person-years) have increased in many regions during the last 5 decades, particularly in North America, Northwestern Europe, and Australia. The increasing incidence is likely attributed to the increasing prevalence of the main risk factors, that is, gastroesophageal reflux disease (GERD) and obesity, combined with a decreasing prevalence of the protective exposure Helicobacter pylori- infection. GERD and obesity are now increasingly prevalent also in Asia, indicating that the incidence of EAC will continue to increase globally. Dysplastic BE and early EAC are readily endoscopically treated, and represent ideal conditions for screening because of their strong association with more advanced EAC. But such screening requires targeting of high-risk individuals, who remain to be better delineated. Conclusions: The changing prevalence rates of GERD, obesity, and Helicobacter pylori- infection might drive continued increasing EAC incidence rates worldwide. Targeted screening programs incorporating combinations of risk factors for BE and EAC may reduce mortality in EAC.