BACKGROUND

Both the demographics underlying the sex ratio in the prevalence of Barrett's esophagus (BE) and the status of BE without intestinal metaplasia (IM) are unclear.

AIMS

To establish the demographics of histologically proven BE, IM+ and IM-, over a 15-yr period from a primary referral, endoscopy unit.

PATIENTS AND METHODS

For all BE patients aged 20-89 yr, identified between 1982 and 1996, IM+ or IM-, prevalences were calculated per 100 first endoscopies.

RESULTS

A total of 492 cases of BE, 320 (248 IM+) in males, 175 (127 IM+) in females were identified in 21,899 first endoscopies (10,939 males, 10,960 females). Between ages 20 and 59 yr in males and 20-79 in females, IM+, IM- and all BE prevalences rose by +/-7.36% for each additional year of age (p= 0.92) with, however, a 20-yr age shift between the sexes, resulting in a male:female OR 4.15 95% CI 2.99-5.77. A declining rate of increase in over 59 males resulted in an overall male:female OR 2.14, 95% CI 1.77-2.58. Over the age of 79 yr, BE prevalences/100 first endoscopies fell from a maximum of 5.1 in males and 3.65 in females to 3.38 and 2.53, respectively.

CONCLUSION

The 4:1 sex ratio and 20-yr age shift between males and females in the prevalence of BE, both IM+ and IM-, found in younger age groups, was the main cause of the overall BE 2:1 sex ratio. The very similar demographics of IM- and IM+ BE suggest they may be two consecutive stages in the same metaplastic process.