Prevalence of Barrett's Esophagus and Esophageal Adenocarcinoma With and Without Gastroesophageal Reflux: A Systematic Review and Meta-analysis

BACKGROUND AND AIMS: Although gastroesophageal re fl ux disease (GERD) symptoms are an essential criterion for Barrett ' s esophagus (BE) screening in most gastroenterology society guidelines, a signi fi cant proportion of BE and esophageal adenocarcinoma (EAC) cases do not endorse them. In a systematic review and meta -analysis, we aimed to study the prevalence of BE/EAC in those with and without GERD. METHODS: A systematic search was conducted through 5 major databases for studies reporting prevalence of BE/EAC in patients with and without GERD. Pooled proportions and odds ratios (ORs) of BE, long -segment BE, short -segment BE, dysplasia, and EAC in patients with and without GERD were synthesized. RESULTS: Forty-three articles (12,883 patients with GERD; 51,350 patients without GERD) were included in the fi nal analysis. BE prevalence was 7% (95% con fi dence interval [CI], 5.8% - 8.5%) and 2.2% (95% CI, 1.6% - 3%) among individuals with and without GERD, respectively. EAC prevalence was 0.6% (95% CI, 0.4% - 1%) and 0.1% (95% CI, 0% - 0.2%) in those with and without GERD, respectively. The overall risks for BE (OR, 2.91; 95% CI, 2.06 - 4.11) and long -segment BE (OR,4.17; 95% CI, 1.78 - 9.77) were higher in patients with GERD, but the risk for short -segment BE (OR, 1.77; 95% CI, 0.89 - 3.52) did not differ between the two groups. In 9 population -based high -quality studies (2244 patients with GERD; 3724 patients without GERD), BE prevalence in patients without GERD was 4.9% (95% CI, 2.6% - 9%). BE prevalence was highest in North American studies (10.6% [GERD] and 4.8% [non-GERD]). CONCLUSIONS: BE prevalence in those without GERD is substantial, particularly in large high -quality population -based studies. These data are important to factor in future BE/EAC early detection guidelines.