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Barrett’s Esophagus in the Asian Population

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The Rise of Acid Reflux in Asia

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Abstract

In Asia, the prevalence of Barrett’s esophagus derived from study of subjects undergoing endoscopy investigation is low compared to rates reported in Europe and North America. In Southeast and East Asia, where most of the existing data in Asia has been gathered, the prevalence of Barrett’s esophagus in various populations studied mostly remains below 5%. As detection and, thereafter, diagnosis of Barrett’s esophagus are highly dependent on recognition of the condition, there is evidence that lack of awareness of the condition in the region could have resulted in underdiagnosis of the disease. Despite this, the prevalence of Barrett’s esophagus is beginning to rise in some parts of Asia.

Asians share many risk factors for Barrett’s esophagus that are common with the populations in Europe and North America. Advancing age, male gender, and presence of reflux symptoms, esophagitis, or hiatal hernia have been identified as risk factors in Asians. Barrett’s esophagus in Asians is characteristically milder than that of the Westerners, with nearly half of those affected being asymptomatic. Given that more than 90% of Barrett’s esophagus cases in the Asian population are short-segment types, it is not surprising the incidence of Barrett’s esophagus-associated esophageal adenocarcinoma is low in Asia. Endoscopic surveillance with random four-quadrant biopsies for patients with non-dysplastic Barrett’s esophagus is not commonly carried out in Asian populations. Development of real-time in vivo and objective imaging technologies may help overcome this limitation. Similar to the situation in the West, there is still no agreement on management strategies for Barrett’s esophagus and its related neoplasia in Asia.

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References

  1. Ho KY. From GERD to Barrett’s esophagus: is the pattern in Asia mirroring that in the west? J Gastroenterol Hepatol. 2011;26(5):816–24.

    Article  PubMed  Google Scholar 

  2. Hongo M, Nagasaki Y, Shoji T. Epidemiology of esophageal cancer: orient to occident. Effects of chronology, geography and ethnicity. J Gastroenterol Hepatol. 2009;24(5):729–35.

    Article  PubMed  Google Scholar 

  3. Ho KY. Asia-Pacific Barrett’s consortium. Is Barrett’s esophagus an over-hyped disease in the west, and an underdiagnosed disease in the East? Dig Endosc. 2013;25(Suppl 2):157–61.

    Article  PubMed  Google Scholar 

  4. Jung HK. Epidemiology of gastroesophageal reflux disease in Asia: a systematic review. J Neurogastroenterol Motil. 2011;17(1):14–27.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Huang Q, Fang DC, Yu CG, Zhang J, Chen MH. Barrett’s esophagus-related diseases remain uncommon in China. J Dig Dis. 2011;12(6):420–7.

    Article  PubMed  Google Scholar 

  6. Amano Y, Kushiyama Y, Yuki T, Takahashi Y, Moriyama I, Fukuhara H, et al. Prevalence of and risk factors for Barrett’s esophagus with intestinal predominant mucin phenotype. Scand J Gastroenterol. 2006;41(8):873–9.

    Article  PubMed  Google Scholar 

  7. Fock KM, Ang TL. Global epidemiology of Barrett’s esophagus. Expert Rev Gastroenterol Hepatol. 2011 Feb;5(1):123–30.

    Article  PubMed  Google Scholar 

  8. Hongo M. Review article: Barrett’s oesophagus and carcinoma in Japan. Aliment Pharmacol Ther. 2004 Dec;20(Suppl 8):50–4.

    Article  PubMed  Google Scholar 

  9. Manabe N, Matsueda K, Haruma K, Yamamoto H, Matsumoto H, et al. The incidence of Barrett’s esophagus and adenocarcinoma are still low in Japan. Gastroenterology. 2011;140(5):S222.

    Google Scholar 

  10. Tseng PH, Lee YC, Chiu HM, Huang SP, Liao WC, Chen CC, et al. Prevalence and clinical characteristics of Barrett’s esophagus in a Chinese general population. J Clin Gastroenterol. 2008;42(10):1074–9.

    Article  PubMed  Google Scholar 

  11. Chang CY, Lee YC, Lee CT, Tu CH, Hwang JC, Chiang H, 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(1):13–20.

    Article  PubMed  Google Scholar 

  12. Kuo CJ, Lin CH, Liu NJ, Wu RC, Tang JH, Cheng CL. Frequency and risk factors for Barrett’s esophagus in Taiwanese patients: a prospective study in a tertiary referral center. Dig Dis Sci. 2010;55(5):1337–43.

    Article  PubMed  Google Scholar 

  13. Park JJ, Kim JW, Kim HJ, Chung MG, Park SM, Baik GH, et al. The prevalence of and risk factors for Barrett’s esophagus in a Korean population: s nationwide multicenter prospective study. J Clin Gastroenterol. 2009;43(10):907–14.

    Article  PubMed  Google Scholar 

  14. Lee IS, Choi SC, Shim KN, Jee SR, Huh KC, Lee JH. Lee et al. prevalence of Barrett’s esophagus remains low in the Korean population: nationwide cross-sectional prospective multicenter study. Dig Dis Sci. 2010;55(7):1932–9.

    Article  PubMed  Google Scholar 

  15. Choi CY, Suh S, Park JS, Lee HJ, Lee JS, Choi HS, et al. The prevalence of Barrett’s esophagus and the comparison of Barrett’s esophagus with cardiac intestinal metaplasia in the health screening at a secondary care hospital. Korean J Gastroenterol. 2012;60(4):219–23.

    Article  PubMed  Google Scholar 

  16. Zhang M, Fan XS, Zou XP. The prevalence of Barrett’s esophagus remains low in eastern China. Single-center 7-year descriptive study. Saudi Med J. 2012;33(12):1324–9.

    PubMed  Google Scholar 

  17. Xiong LS, Cui Y, Wang JP, Wang JH, Xue L, Hu PJ, et al. Prevalence and risk factors of Barrett’s esophagus in patients undergoing endoscopy for upper gastrointestinal symptoms. J Dig Dis. 2010;11(2):83–7.

    Article  PubMed  Google Scholar 

  18. Peng S, Cui Y, Xiao YL, Xiong LS, Hu PJ, Li CJ, et al. Prevalence of erosive esophagitis and Barrett’s esophagus in the adult Chinese population. Endoscopy. 2009;41(12):1011–7.

    Article  CAS  PubMed  Google Scholar 

  19. Zhang RG, Wang CS, Gao CF. Prevalence and pathogenesis of Barrett’s esophagus in Luoyang. China Asian Pac J Cancer Prev. 2012;13(5):2185–91.

    Article  PubMed  Google Scholar 

  20. Yin C, Zhang J, Gao M, Shen Q, Dong L. Epidemiological investigation of Barrett’s esophagus in patients with gastroesophageal reflux disease in Northwest China. J Med College PLA. 2012;27(4):187–97.

    Article  Google Scholar 

  21. Lee YY, Tuan Sharif SE, Syed Abd Aziz SH, Raj SM. Barrett’s esophagus in an area with an exceptionally low prevalence of helicobacter pylori Infection. ISRN Gastroenterol. 2011;2011:394734.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Rosaida MS, Goh KL. Gastro-oesophageal reflux disease, reflux oesophagitis and non-erosive reflux disease in a multiracial Asian population: a prospective, endoscopy based study. Eur J Gastroenterol Hepatol. 2004 May;16(5):495–501.

    Article  PubMed  Google Scholar 

  23. Rajendra S, Kutty K, Karim N. Ethnic differences in the prevalence of endoscopic esophagitis and Barrett’s esophagus: the long and short of it all. Dig Dis Sci. 2004;49(2):237–42.

    Article  PubMed  Google Scholar 

  24. Dhawan PS, Alvares JF, Vora IM, Joseph TK, Bhatia SJ, Amarapurkar AD, et al. Prevalence of short segments of specialized columnar epithelium in distal esophagus: association with gastroesophageal reflux. Indian J Gastroenterol. 2001;20(4):144–7.

    CAS  PubMed  Google Scholar 

  25. Mathew P, Joshi AS, Shukla A, Bhatia SJ. Risk factors for Barrett’s esophagus in Indian patients with gastroesophageal reflux disease. J Gastroenterol Hepatol. 2011;26(7):1151–6.

    Article  PubMed  Google Scholar 

  26. Goh KL. Changing epidemiology of gastroesophageal reflux disease in the Asian-Pacific region: an overview. J Gastroenterol Hepatol. 2004;19(Suppl 3):S22–5.

    Article  PubMed  Google Scholar 

  27. Li XH, Chang CY, Goto H, et al. Formal training in the endoscopic recognition of Barrett’s esophagus improves detection rate and increases diagnostic yield. J Gastroenterol Hepatol. 2011;26(Suppl 5):213.

    Google Scholar 

  28. Wang KK, Sampliner RE. Practice parameters Committee of the American College of gastroenterology. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol. 2008 Mar;103(3):788–97.

    Article  PubMed  Google Scholar 

  29. Playford RJ. New British Society of Gastroenterology (BSG) guidelines for the diagnosis and management of Barrett’s oesophagus. Gut. 2006;55(4):442.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Ishimura N, Amano Y, Appelman HD, Penagini R, Tenca A, Falk GW, et al. Barrett’s esophagus: endoscopic diagnosis. Ann N Y Acad Sci. 2011;1232:53–75.

    Article  PubMed  Google Scholar 

  31. Ogiya K, Kawano T, Ito E, Nakajima Y, Kawada K, Nishikage T, et al. Lower esophageal palisade vessels and the definition of Barrett’s esophagus. Dis Esophagus. 2008;21:645–9.

    Article  CAS  PubMed  Google Scholar 

  32. Lee YC, Cook MB, Bhatia S, Chow WH, El-Omar EM, Goto H, et al. Interobserver reliability in the endoscopic diagnosis and grading of Barrett’s esophagus: an Asian multinational study. Endoscopy. 2010;42(9):699–704.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Bergholt MS, Zheng W, Ho KY, Teh M, Yeoh KG, So JB, et al. Fiberoptic confocal Raman spectroscopy for real-time in vivo diagnosis of dysplasia in Barrett’s esophagus. Gastroenterology. 2014;146(1):27–32.

    Article  PubMed  Google Scholar 

  34. Wang X, Ouyang H, Yamamoto Y, Kumar PA, Wei TS, Dagher R, et al. Residual embryonic cells as precursors of a Barrett’s-like metaplasia. Cell. 2011;145(7):1023–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Xian W, Ho KY, Crum CP, McKeon F. Cellular origin of Barrett’s esophagus: controversy and therapeutic implications. Gastroenterology. 2012;142(7):1424–30.

    Article  PubMed  Google Scholar 

  36. Sollano JD, Wong SN, Andal-Gamutan T, Chan MM, Carpio RE, Tady CS, et al. Erosive esophagitis in the Philippines: a comparison between two time periods. J Gastroenterol Hepatol. 2007;22(10):1650–5.

    Article  PubMed  Google Scholar 

  37. Okita K, Amano Y, Takahashi Y, Mishima Y, Moriyama N, Ishimura N, et al. Barrett’s esophagus in Japanese patients: its prevalence, form, and elongation. J Gastroenterol. 2008;43:928–34.

    Article  PubMed  Google Scholar 

  38. Chen X, Zhu LR, Hou XH. The characteristics of Barrett’s esophagus: an analysis of 4120 cases in China. Dis Esophagus. 2009;22(4):348–53.

    Article  PubMed  Google Scholar 

  39. Kang JY. Systematic review: geographical and ethnic differences in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2004;20(7):705–17.

    Article  CAS  PubMed  Google Scholar 

  40. Sharma P, Wani S, Romero Y, Johnson D, Hamilton F. Racial and geographic issues in gastroesophageal reflux disease. Am J Gastroenterol. 2008;103(11):2669–80.

    Article  PubMed  Google Scholar 

  41. Rajendra S. Barrett’s oesophagus in Asians--are ethnic differences due to genes or the environment? J Intern Med. 2011;270(5):421–7.

    Article  CAS  PubMed  Google Scholar 

  42. Rajendra S, Ackroyd R, Murad S, Mohan C, Too CL, Azrena A. Barrett’s oesophagus and HLA-B*0702/HLA-B*0706. Aliment Pharmacol Ther. 2006;23(9):1375–6.

    Article  CAS  PubMed  Google Scholar 

  43. Akiyama T, Inamori M, Akimoto K, Iida H, Mawatari H, Endo H, et al. Risk factors for the progression of endoscopic Barrett’s epithelium in Japan: a multivariate analysis based on the Prague C & M Criteria. Dig Dis Sci. 2009;54:1702–7.

    Article  CAS  PubMed  Google Scholar 

  44. Chang CY, Cook MB, Lee YC, Lin JT, Ando T, Bhatia S, et al. Current status of Barrett’s esophagus research in Asia. J Gastroenterol Hepatol. 2011;26(2):240–6.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Taylor JB, Rubenstein JH. Meta-analyses of the effect of symptoms of gastroesophageal reflux on the risk of Barrett’s esophagus. Am J Gastroenterol. 2010;105(8):1729–37.

    Article  PubMed  Google Scholar 

  46. Navarathne NM, Abeysuriya V, Ileperuma A, Thoufeek UL. Endoscopic observations around the gastroesophageal junction in patients with symptomatic gastroesophageal reflux disease in South Asia. Indian J Gastroenterol. 2010;29(5):184–6.

    Article  PubMed  Google Scholar 

  47. Fujimoto A, Hoteya S, Iizuka T, Ogawa O, Mitani T, Kuroki Y, et al. Obesity and gastrointestinal diseases. Gastroenterol Res Pract. 2013;2013:760574.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Kim JH, Rhee PL, Lee JH, Lee H, Choi YS, Son HJ, et al. Prevalence and risk factors of Barrett’s esophagus in Korea. J Gastroenterol Hepatol. 2007;22(6):908–12.

    Article  PubMed  Google Scholar 

  49. Bamanikar AA, Diwan AG, Benoj DE, Bamanikar SA. Barrett’s metaplasia in Indian obese male patients with gastro-oesophageal reflux disease. J Indian Med Assoc. 2011;109(7):483–4.

    CAS  PubMed  Google Scholar 

  50. Fischbach LA, Nordenstedt H, Kramer JR, Gandhi S, Dick-Onuoha S, Lewis A, El-Serag HB. The association between Barrett’s esophagus and helicobacter pylori infection: a meta-analysis. Helicobacter. 2012;17(3):163–75.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Abe Y, Koike T, Iijima K, Imatani A, Ishida K, Yuki T, et al. Esophageal adenocarcinoma developing after eradication of helicobacter pylori. Case Rep Gastroenterol. 2011;5(2):355–60.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Abe Y, Iijima K, Koike T, Asanuma K, Imatani A, Ohara S, et al. Barrett’s esophagus is characterized by the absence of helicobacter pylori infection and high levels of serum pepsinogen I concentration in Japan. J Gastroenterol Hepatol. 2009;24(1):129–34.

    Article  PubMed  Google Scholar 

  53. Ho KY, Chan YH, Kang JY. Increasing trend of reflux esophagitis and decreasing trend of helicobacter pylori infection in patients from a multiethnic Asian country. Am J Gastroenterol. 2005;100:1923–8.

    Article  PubMed  Google Scholar 

  54. Rajendra S, Ackroyd R, Robertson IK, Ho JJ, Karim N, Kutty KM. Helicobacter pylori, ethnicity, and the gastroesophageal reflux disease spectrum: a study from the East. Helicobacter. 2007;12:177–83.

    Article  PubMed  Google Scholar 

  55. Fernandes ML, Seow A, Chan YH, Ho KY. Opposing trends in incidence of esophageal squamous cell carcinoma and adenocarcinoma in a multi-ethnic Asian country. Am J Gastroenterol. 2006;101(7):1430–6.

    Article  PubMed  Google Scholar 

  56. Yee YK, Cheung TK, Chan AO, Yuen MF, Wong BC. Decreasing trend of esophageal adenocarcinoma in Hong Kong. Cancer Epidemiol Biomark Prev. 2007;16(12):2637–40.

    Article  Google Scholar 

  57. Chung JW, Lee GH, Choi KS, Kim DH, Jung KW, Song HJ, et al. Unchanging trend of esophagogastric junction adenocarcinoma in Korea: experience at a single institution based on Siewert’s classification. Dis Esophagus. 2009;22(8):676–81.

    Article  PubMed  Google Scholar 

  58. Lu CL, Lang HC, Luo JC, Liu CC, Lin HC, Chang FY, et al. Increasing trend of the incidence of esophageal squamous cell carcinoma, but not adenocarcinoma, in Taiwan. Cancer Causes Control. 2010;21(2):269–74.

    Article  PubMed  Google Scholar 

  59. Hvid-Jensen F, Pedersen L, Drewes AM, Sørensen HT, Funch-Jensen P. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med. 2011;365(15):1375–83.

    Article  CAS  PubMed  Google Scholar 

  60. Lee SY, Yasuda K, Yasuda I, Ho LKY, Ahn SY, Lee TY, et al. Different managements for esophageal epithelial neoplasms between the Japanese, Singaporean, and Korean endoscopists. Korean J Helicobacter Upper Gastrointest Res. 2011;11(1):59–64.

    Article  Google Scholar 

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Authors and Affiliations

  1. National University of Singapore/National University Hospital, 1E Kent Ridge Road NUHS Tower Block, Level 10, Singapore, 119228, Singapore

    Khek Yu Ho

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Editors and Affiliations

  1. University of Kansas School of Medicine, VA Medical Center, Kansas city, MO, USA

    Prateek Sharma

  2. Gastroenterology, KEM Hospital, Mumbai, Maharashtra, India

    Shobna Bhatia

  3. University of Malaya, Kuala Lumpur, Malaysia

    Khean Lee Goh

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Ho, K.Y. (2018). Barrett’s Esophagus in the Asian Population. In: Sharma, P., Bhatia, S., Goh, K. (eds) The Rise of Acid Reflux in Asia. Springer, New Delhi. https://doi.org/10.1007/978-81-322-0846-4_10

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  • DOI: https://doi.org/10.1007/978-81-322-0846-4_10

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