Temporal changes in the endoscopic frequency of new cases of Barrett's esophagus in an australian health region

OBJECTIVES: The number of patients diagnosed with Barrett's esophagus (BE) has increased in recent decades, although data from populations outside Europe and North America are scarce. This increase has significant implications for health resource utilization and costs. We sought to determine changes in the endoscopic frequency of new cases of BE in an Australian population during the period 1990-2002. METHODS: We identified all persons newly diagnosed with BE in an Australian health region in 1990, 1998, and 2002. BE cases were categorized as short segment (SSBE) (< 3 cm), long segment (>= 3 cm), or undefined length. We compared the total number of esophagogastroduodenoscopies (EGD) and the number of new cases of BE for the three time periods. RESULTS: Between 1990 and 2002, the endoscopic frequency of new cases of BE increased from 2.9 to 18.9 per 1,000 endoscopies (p < 0.001). The greatest increase was for SSBE, increasing from no new cases in 1990 to 6.2 new cases per 1,000 EGD in 2002. In contrast there was a 17% decrease (2.3-1.9 new cases per 1,000 EGD) for long segment BE during the same period. There were 3,090 EGDs undertaken in 1990, 3,518 in 1998, and 2,593 in 2002, an increase of 14% over the first 8-yr interval (p < 0.001), and a decline of 26% over the subsequent 4 yr (p < 0.001). CONCLUSIONS: In an Australian population undergoing EGD, the endoscopic frequency and absolute number of new cases of BE, particularly SSBE disease, has increased significantly between 1990 and 2002. This increased frequency of patients diagnosed with BE has broad future economic and clinical implications.