Digestive Diseases and Sciences

, Volume 55, Issue 5, pp 1337–1343 | Cite as

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

  • Chia-Jung Kuo
  • Cheng-Hui Lin
  • Nai-Jen Liu
  • Ren-Chin Wu
  • Jui-Hsiang Tang
  • Chi-Liang Cheng
Original Article



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.


Barrett’s esophagus Gastro-esophageal reflux disease Endoscopy Hiatal hernia 


  1. 1.
    Falk GW. Barrett’s esophagus. Gastroenterology. 2002;122:1569–1591. doi: 10.1053/gast.2002.33427.CrossRefPubMedGoogle Scholar
  2. 2.
    Hongo M. Review article: Barrett’s oesophagus and carcinoma in Japan. Aliment Pharmacol Ther. 2004;20(8):50–54. doi: 10.1111/j.1365-2036.2004.02230.x.CrossRefPubMedGoogle Scholar
  3. 3.
    Yeh C, Hsu CT, Ho AS, et al. Erosive esophagitis and Barrett’s esophagus in Taiwan: a higher frequency than expected. Dig Dis Sci. 1997;42:702–706. doi: 10.1023/A:1018835324210.CrossRefPubMedGoogle Scholar
  4. 4.
    Menke-Pluymers MB, Hop WC, Dees J, et al. Risk factors for the development of an adenocarcinoma in columnar-lined (Barrett) esophagus. The Rotterdam Esophageal Tumor Study Group. Cancer. 1993;72:1155–1158. doi: 10.1002/1097-0142(19930815)72:4<1155::AID-CNCR2820720404>3.0.CO;2-C.CrossRefPubMedGoogle Scholar
  5. 5.
    Sharma P, Morales TG, Sampliner RE. Short segment Barrett’s esophagus—the need for standardization of the definition and of endoscopic criteria. Am J Gastroenterol. 1998;93:1033–1036.PubMedGoogle Scholar
  6. 6.
    Dekel R, Wakelin DE, Wendel C, et al. Progression or regression of Barrett’s esophagus—is it all in the eye of the beholder? Am J Gastroenterol. 2003;98:2612–2615.PubMedGoogle Scholar
  7. 7.
    Sharma P, Dent J, Armstrong D, et al. The development and validation of an endoscopic grading system for Barrett’s esophagus: the Prague C & M criteria. Gastroenterology. 2006;131:1392–1399. doi: 10.1053/j.gastro.2006.08.032.CrossRefPubMedGoogle Scholar
  8. 8.
    Vakil N, van Zanten SV, Kahrilas P, et al; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–1920. doi: 10.1111/j.1572-0241.2006.00630.x.CrossRefPubMedGoogle Scholar
  9. 9.
    Locke GR, Talley NJ, Weaver AL, et al. A new questionnaire for gastroesophageal reflux disease. Mayo Clin Proc. 1994;69:539–547.PubMedGoogle Scholar
  10. 10.
    Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–180.CrossRefPubMedGoogle Scholar
  11. 11.
    Lee JI, Park H, Jung HY, et al. Prevalence of Barrett’s esophagus in an urban Korean population: a multicenter study. J Gastroenterol. 2003;38:23–27. doi: 10.1007/s005350300002.CrossRefPubMedGoogle Scholar
  12. 12.
    Azuma N, Endo T, Arimura Y, et al. Prevalence of Barrett’s esophagus and expression of mucin antigens detected by a panel of monoclonal antibodies in Barrett’s esophagus and esophageal adenocarcinoma in Japan. J Gastroenterol. 2000;35:583–592. doi: 10.1007/s005350070057.CrossRefPubMedGoogle Scholar
  13. 13.
    Kim JY, Kim YS, Jung MK, et al. Prevalence of Barrett’s esophagus in Korea. J Gastroenterol Hepatol. 2005;20:633–636. doi: 10.1111/j.1440-1746.2005.03749.x.CrossRefPubMedGoogle Scholar
  14. 14.
    Lee YC, Wang HP, Chiu HM, et al. Comparative analysis between psychological and endoscopic profiles in patients with gastroesophageal reflux disease: a prospective study based on screening endoscopy. J Gastroenterol Hepatol. 2006;21:798–804. doi: 10.1111/j.1440-1746.2005.04034.x.CrossRefPubMedGoogle Scholar
  15. 15.
    Tseng PH, Lee YC, Chiu HM, et al. Prevalence and clinical characteristics of Barrett’s esophagus in a Chinese general population. J Clin Gastroenterol. 2008;42:1074–1079. doi: 10.1097/MCG.0b013e31809e7126.CrossRefPubMedGoogle Scholar
  16. 16.
    Chang CY, Lee YC, Lee CT, et al. The application of Prague C and M criteria in the diagnosis of Barrett's esophagus in an ethnic Chinese population. Am J Gastroenterol. 2009;104:13–20. doi: 10.1038/ajg.2008.43.CrossRefPubMedGoogle Scholar
  17. 17.
    Eloubeidi MA, Provenzale D. Clinical and demographic predictors of Barrett’s esophagus among patients with gastroesophageal reflux disease: a multivariable analysis in veterans. J Clin Gastroenterol. 2001;33:306–309. doi: 10.1097/00004836-200110000-00010.CrossRefPubMedGoogle Scholar
  18. 18.
    Avidan B, Sonnenberg A, Schnell TG, et al. Hiatal hernia and acid reflux frequency predict presence and length of Barrett’s esophagus. Dig Dis Sci. 2002;47:256–264. doi: 10.1023/A:1013797417170.CrossRefPubMedGoogle Scholar
  19. 19.
    El-Serag HB, Kvapil P, Hacken-Bitar J, et al. Abdominal obesity and the risk of Barrett’s esophagus. Am J Gastroenterol. 2005;100:2151–2156. doi: 10.1111/j.1572-0241.2005.00251.x.CrossRefPubMedGoogle Scholar
  20. 20.
    Corley DA, Kubo A, Levin TR, et al. Abdominal obesity and body mass index as risk factors for Barrett’s esophagus. Gastroenterology. 2007;133:34–41. doi: 10.1053/j.gastro.2007.04.046.CrossRefPubMedGoogle Scholar
  21. 21.
    Lagergren J, Bergström R, Lindgren A, et al. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med. 1999;340:825–831. doi: 10.1056/NEJM199903183401101.CrossRefPubMedGoogle Scholar
  22. 22.
    Lieberman DA, Oehlke M, Helfand M. Risk factors for Barrett’s esophagus in community-based practice. GORGE consortium. Gastroenterology Outcomes Research Group in Endoscopy. Am J Gastroenterol. 1997;92:1293–1297.PubMedGoogle Scholar
  23. 23.
    Cameron AJ. Barrett’s esophagus: prevalence and size of hiatal hernia. Am J Gastroenterol. 1999;94:2054–2059. doi: 10.1111/j.1572-0241.1999.01277.x.CrossRefPubMedGoogle Scholar
  24. 24.
    Anandasabapathy S, Jhamb J, Davila M, et al. Clinical and endoscopic factors predict higher pathologic grades of Barrett dysplasia. Cancer. 2007;109:668–674. doi: 10.1002/cncr.22451.CrossRefPubMedGoogle Scholar
  25. 25.
    Ronkainen J, Aro P, Storskrubb T, et al. Prevalence of Barrett’s esophagus in the general population: an endoscopic study. Gastroenterology. 2005;129:1825–1831. doi: 10.1053/j.gastro.2005.08.053.CrossRefPubMedGoogle Scholar
  26. 26.
    Weston AP, Badr AS, Topalovski M, et al. Prospective evaluation of the prevalence of gastric Helicobacter pylori infection in patients with GERD, Barrett’s esophagus, Barrett’s dysplasia, and Barrett’s adenocarcinoma. Am J Gastroenterol. 2000;95:387–394. doi: 10.1111/j.1572-0241.2000.01758.x.CrossRefPubMedGoogle Scholar
  27. 27.
    Endlicher E, Rümmele P, Beer S, et al. Barrett’s esophagus: a discrepancy between macroscopic and histological diagnosis. Endoscopy. 2005;37:1131–1135. doi: 10.1055/s-2005-870409.CrossRefPubMedGoogle Scholar
  28. 28.
    Bak YT, Jung GM, Yeon JE, et al. Validity of the specialized columnar epithelium as a diagnostic criterion of the short segment Barrett’s esophagus. Korean J Intern Med. 1998;13:99–103.PubMedGoogle Scholar
  29. 29.
    Trudgill NJ, Suvarna SK, Kapur KC, et al. Intestinal metaplasia at the squamocolumnar junction in patients attending for diagnostic gastroscopy. Gut. 1997;41:585–589.PubMedCrossRefGoogle Scholar
  30. 30.
    Harrison R, Perry I, Haddadin W, et al. Detection of intestinal metaplasia in Barrett’s esophagus: an observational comparator study suggests the need for a minimum of eight biopsies. Am J Gastroenterol. 2007;102:1154–1161. doi: 10.1111/j.1572-0241.2007.01230.x.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Chia-Jung Kuo
    • 1
  • Cheng-Hui Lin
    • 1
  • Nai-Jen Liu
    • 1
    • 3
  • Ren-Chin Wu
    • 2
  • Jui-Hsiang Tang
    • 1
  • Chi-Liang Cheng
    • 1
    • 3
  1. 1.Department of Gastroenterology and HepatologyChang Gung Memorial HospitalTaoyuanTaiwan
  2. 2.Department of PathologyChang Gung Memorial HospitalTaoyuanTaiwan
  3. 3.Department of MedicineChang Gung Memorial Hospital, Chang Gung UniversityQueishanTaoyuan CountyTaiwan

Personalised recommendations