Division of Gastroenterology and Hepatology, Archbold Medical Group/Florida State University, Thomasville, Georgia, USA.
Division of Physical Therapy, School of Allied Health Sciences, Florida A & M University, Tallahassee, Florida, USA.
Gastrointest Endosc. 2019 Nov;90(5):707-717.e1. doi: 10.1016/j.gie.2019.05.030. Epub 2019 May 29.
Although screening for Barrett's esophagus (BE) is recommended in individuals with multiple risk factors, the type and number of risk factors necessary to trigger screening is unclear. In this systematic review and meta-analysis, we aimed to assess the relationship between number of risk factors and prevalence of BE.
Through October 17, 2018 we searched studies that described the prevalence of BE in the general population and based on presence of risk factors that included GERD, male gender, age >50 years, family history of BE and esophageal adenocarcinoma, and obesity (defined as body mass index >35). Risk of BE based on number of risk factors was assessed using meta-regression while controlling for potential confounders.
Of 2741 studies, 49 were included in the analysis (307,273 individuals, 1948 with biopsy specimen-proven BE). Indications varied by study. The prevalence of BE for various populations was as follows: low-risk general population, .8% (95% confidence interval [CI], .6%-1.1%); GERD, 3% (95% CI, 2.3%-4%); GERD plus presence of any other risk factor, 12.2% (95% CI, 10.2%-14.6%); family history, 23.4% (95% CI, 13.7% -37.2%); age >50, 6.1% (95% CI, 4.6%-8.1%); obesity, 1.9% (95% CI, 1.2%-3%); and male sex, 6.8% (95% CI, 5.3%-8.6%). Prevalence of BE varied significantly between Western and non-Western populations. In a meta-regression, controlling for the region of the study, age, and gender, there was a positive linear relationship between the number of risk factors and the prevalence of BE.
Results of this study provide estimates of BE prevalence based on the presence and the number of risk factors. These results add credence to current guidelines that suggest screening in the presence of multiple risk factors.
尽管推荐对具有多种危险因素的个体进行 Barrett 食管（BE）筛查，但触发筛查所需的危险因素类型和数量尚不清楚。在本系统评价和荟萃分析中，我们旨在评估危险因素数量与 BE 患病率之间的关系。
截至 2018 年 10 月 17 日，我们检索了描述一般人群中 BE 患病率的研究，并根据存在 GERD、男性、年龄>50 岁、BE 和食管腺癌家族史以及肥胖（定义为 BMI>35）等危险因素的情况进行了描述。使用元回归评估基于危险因素数量的 BE 风险，同时控制潜在混杂因素。
在 2741 项研究中，有 49 项研究纳入分析（307273 名个体，1948 名活检证实有 BE）。研究的指征各不相同。不同人群的 BE 患病率如下：低危一般人群，0.8%（95%置信区间[CI]，0.6%-1.1%）；GERD，3%（95%CI，2.3%-4%）；GERD 加任何其他危险因素，12.2%（95%CI，10.2%-14.6%）；家族史，23.4%（95%CI，13.7%-37.2%）；年龄>50 岁，6.1%（95%CI，4.6%-8.1%）；肥胖，1.9%（95%CI，1.2%-3%）；男性，6.8%（95%CI，5.3%-8.6%）。BE 的患病率在西方和非西方人群之间差异显著。在元回归中，控制研究区域、年龄和性别，危险因素数量与 BE 患病率之间呈正线性关系。
本研究结果提供了基于危险因素的存在和数量的 BE 患病率估计。这些结果为目前建议在存在多种危险因素的情况下进行筛查的指南提供了依据。
