Frequency and Risk Factors for Barrett's Esophagus in Taiwanese Patients: A Prospective Study in a Tertiary Referral Center

There is a paucity of epidemiologic data concerning Barrett's esophagus (BE) in Taiwan. This study aimed to investigate the frequency of and risk factors for BE in self-referred Taiwanese patients undergoing diagnostic endoscopy. A total of 736 consecutive patients undergoing upper endoscopy for a variety of gastro-intestinal symptoms from February to October 2007 were evaluated. A standard questionnaire was used to record the clinical characteristics and patient symptoms. Gastro-esophageal reflux disease (GERD) was diagnosed using the Montreal definition, while the Los Angeles Classification and Prague Circumferential and Maximal Criteria were used to assess erosive esophagitis and BE, respectively. Four-quadrant biopsies were taken from endoscopically suspected esophageal metaplastic mucosa every 2 cm for histologic evaluation. Eight variables were tested using a logistic regression model to identify risk factors for BE in GERD patients. GERD was diagnosed in 344 patients, with typical esophageal symptoms noted in 255, reflux chest pain syndrome in 107, and extra-esophageal syndrome in 51, while 27 were asymptomatic. The mean age of the GERD patients was 49.8 years and 55.5% of them were male. Thirty-six percent (123 of 344) demonstrated erosive esophagitis and 95% were classified as having Los Angeles grade A or B disease. BE was diagnosed in 13 patients (3.8% of GERD patients), three of whom had dysplastic mucosa. In the final analysis model, hiatal hernia (odds ratio [OR] = 4.7, 95% confidence interval [CI] = 1.3-17.7, P = 0.02) and GERD duration > 5 years (OR = 4.2, 95% CI = 1.2-4.8, P = 0.03) were independent risk factors for the development of BE. There is a 3.8% frequency of BE in Taiwanese GERD patients. Hiatal hernia and prolonged GERD duration are significant risk factors.