Systematic review and meta-analysis of prevalence and risk factors for Barrett’s esophagus

Abstract Background and Aims 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. Methods 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 (EAC), 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. Results Of 2,741 studies, 49 were included in the analysis (307,273 individuals, 1,948 with biopsy-proven BE). Indications varied by study. The prevalence of BE for various populations was as follows: low-risk general population: 0.8% (95% CI, 0.6% – 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. Conclusions 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.