Prevalence of Barrett's esophagus in individuals without typical symptoms of gastroesophageal reflux disease

Abstract

Barretts esophagus, the major risk factor for esophageal adenocarcinoma, is detected in approximately 10%-14% of individuals submitted to upper endoscopy for the assessment of gastroesophageal reflux disease related symptoms. Prevalence studies of Barretts esophagus in individuals without typical symptoms of gastroesophageal reflux disease have reported rates ranging from 0.6% to 25%. To determine the prevalence of Barretts in a Brazilian population older than 50 years without typical symptoms of gastroesophageal reflux disease. A total of 104 patients (51 men), mean age of 65 years, with an indication for upper endoscopy but without symptoms of heartburn and/or acid regurgitation (determined with a validated questionnaire) were recruited. Subjects submitted to upper endoscopic examination in the last 10 years or using antisecretory medication (proton pump inhibitors) during the last 6 months were not included. Methylene blue chromoscopy was performed during the endoscopic exam to facilitate identification of the metaplastic epithelium. Barretts esophagus was diagnosed endoscopically and confirmed by histology in four patients, all of them males. The metaplastic segment was short (less than 3 cm) and free of dysplasia in all patients. The prevalence of Barretts esophagus was 7.75% in the male population and 3.8% in the general population studied. Due to the low prevalence of Barretts esophagus found in the present study, associated with the finding of short-segment Barretts esophagus in all cases diagnosed and the absence of dysplasia in the material analyzed, endoscopic screening for Barretts esophagus in patients above the age of 50 without the classical symptoms of gastroesophageal reflux disease is not indicated for the Brazilian population.