Background and Aims: Although screening for Barrett's esophagus (BE) is recommended in individuals with multiple risk factors, the type and number of risk factors necessary to trigger screening is unclear. In this systematic review and meta-analysis, we aimed to assess the relationship between number of risk factors and prevalence of BE. Methods: Through October 17, 2018 we searched studies that described the prevalence of BE in the general population and based on presence of risk factors that included GERD, male gender, age >50 years, family history of BE and esophageal adenocarcinoma, and obesity (defined as body mass index >35). Risk of BE based on number of risk factors was assessed using meta-regression while controlling for potential confounders. Results: Of 2741 studies, 49 were included in the analysis (307,273 individuals, 1948 with biopsy specimen–proven BE). Indications varied by study. The prevalence of BE for various populations was as follows: low-risk general population, .8% (95% confidence interval [CI], .6%-1.1%); GERD, 3% (95% CI, 2.3%-4%); GERD plus presence of any other risk factor, 12.2% (95% CI, 10.2%-14.6%); family history, 23.4% (95% CI, 13.7% -37.2%); age >50, 6.1% (95% CI, 4.6%-8.1%); obesity, 1.9% (95% CI, 1.2%-3%); and male sex, 6.8% (95% CI, 5.3%-8.6%). Prevalence of BE varied significantly between Western and non-Western populations. In a meta-regression, controlling for the region of the study, age, and gender, there was a positive linear relationship between the number of risk factors and the prevalence of BE. Conclusions: Results of this study provide estimates of BE prevalence based on the presence and the number of risk factors. These results add credence to current guidelines that suggest screening in the presence of multiple risk factors.
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DISCLOSURE: The following authors disclosed financial relationships relevant to this publication: S. Gross: Consultant for Olympus, Cook, Boston Scientific and Microtech. P. Iyer: Research funding from Exact Sciences , Medtronic , Pentax Medical , and Nine Point Medical ; consultant for Medtronic, Pentax Medical, and Symple Surgical. S. Wani: Consultant for Medtronic and Boston Scientific; research support from the University of Colorado Department of Medicine Outstanding Early Scholars Program . All other authors disclosed no financial relationships relevant to this publication. Research support for this study was provided by the American Society for Gastrointestinal Endoscopy for the subscription of www.covidence.org used in this study.
© 2019 American Society for Gastrointestinal Endoscopy
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