Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2019; 25(25): 3231-3241
Published online Jul 7, 2019. doi: 10.3748/wjg.v25.i25.3231
Prevalence and risk factors for Barrett’s esophagus in Taiwan
Yan-Hua Chen, Hsien-Chung Yu, Kung-Hung Lin, Huey-Shyan Lin, Ping-I Hsu
Yan-Hua Chen, Hsien-Chung Yu, Kung-Hung Lin, Ping-I Hsu, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
Yan-Hua Chen, Hsien-Chung Yu, Kung-Hung Lin, Health Evaluation Center, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
Yan-Hua Chen, Kung-Hung Lin, Department of Nursing, Meiho University, Neipu Township, Pingtung County 91202, Taiwan
Hsien-Chung Yu, Institute of Health Care Management, Department of Business Management, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
Huey-Shyan Lin, Department of Health-Business Administration, Fooyin University, Kaohsiung 83102, Taiwan
Ping-I Hsu, National Yang Ming University, Taipei 12221, Taiwan
Author contributions: All authors helped to perform the research; Chen YH, Yu HC and Hsu PI designed the study and drafted the manuscript; Chen YH and Lin KH collected the data; Chen YH and Lin HS performed statistical analyses; Lin HS and Hsu PI revised the manuscript critically for important intellectual content.
Supported by the In-Hospital Research Project Funding of Kaohsiung Veterans General Hospital, No. VGHKS107-040.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of Kaohsiung Veterans General Hospital (VGHKS17-CT7-07).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ping-I Hsu, MD, Attending Doctor, Professor, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Rd, Zuoying Dist., Kaohsiung 81362, Taiwan. pihsu@vghks.gov.tw
Telephone: +886-7-3422121 Fax: +886-7-3468237
Received: January 8, 2019
Peer-review started: January 8, 2019
First decision: January 30, 2019
Revised: February 24, 2019
Accepted: March 1, 2019
Article in press: March 2, 2019
Published online: July 7, 2019
Processing time: 180 Days and 3.1 Hours
Abstract
BACKGROUND

Barrett’s esophagus (BE) is a pre-malignant condition associated with the development of esophageal adenocarcinoma. The prevalence of BE in the general populations of Asian countries ranges from 0.06% to 1%. However, with lifestyle changes in Asian countries and adoption of western customs, the prevalence of BE might have increased.

AIM

To determine the current prevalence of BE in Taiwan, and to investigate risk factors predicting the presence of BE.

METHODS

This retrospective study was conducted at the Health Evaluation Center of Kaohsiung Veterans General Hospital in Taiwan. Between January 2015 and December 2015, 3385 subjects undergoing routine esophagogastroduodenoscopy examinations as part of a health check-up at the Health Evaluation Center were included. Patient characteristics and endoscopic findings were carefully reviewed. Lesions with endoscopic findings consistent with BE awaiting histological evaluation were judged as endoscopically suspected esophageal metaplasia (ESEM). BE was defined based on extension of the columnar epithelium ≥ 1 cm above the gastroesophageal junction and was confirmed based on the presence of specialized intestinal metaplasia (IM) in the metaplastic esophageal epithelium. Clinical factors of subjects with BE and subjects without BE were compared, and the risk factors predicting BE were analyzed.

RESULTS

A total of 3385 subjects (mean age, 51.29 ± 11.42 years; 57.1% male) were included in the study, and 89 among them were confirmed to have IM and presence of goblet cells via biopsy examination. The majority of these individuals were classified as short segment BE (n = 85). The overall prevalence of BE was 2.6%. Multivariate analysis disclosed that old age [odds ratio (OR) = 1.033; 95% confidence interval (CI): 1.012-1.055; P = 0.002], male gender (OR = 2.106; 95%CI: 1.145-3.872; P = 0.017), ingestion of tea (OR = 1.695; 95%CI: 1.043-2.754; P = 0.033), and presence of hiatal hernia (OR = 3.037; 95%CI: 1.765-5.225; P < 0.001) were significant risk factors predicting BE. The independent risk factor for the presence of IM in ESEM lesions was old age alone (OR = 1.029; 95%CI: 1.006-1.053; P = 0.014).

CONCLUSION

Current prevalence of BE among the general population in Taiwan is 2.6%. Old age, male gender, ingestion of tea and hiatal hernia are significant risk factors for BE.

Keywords: Barrett’s esophagus; Prevalence; Risk factors; Intestinal metaplasia; Taiwan

Core tip: The current prevalence of Barrett’s esophagus (BE), based on the diagnostic criteria of the American College of Gastroenterology, is 2.6% among the general population in Taiwan. Its prevalence in Taiwan is the highest among the general population in Asian countries. Significant risk factors for BE include old age, male gender, ingestion of tea and the presence of hiatal hernia. In clinical practice, more attention should be paid when endoscopically suspected esophageal metaplasia is observed in older individuals, as these lesions have a higher likelihood of bearing intestinal metaplasia.