Barrett's esophagus and endoscopically assessed esophagogastric junction integrity in 1000 consecutive Turkish patients undergoing endoscopy: A prospective study

Abstract

Barrett's esophagus (BE) appears to be more common in Western than in Asian countries. BE is a complication of gastroesophageal reux disease (GERD). Anatomical abnormalities of the esophagogastric junc-tion (EGJ) are an important factor in the pathogenesis of GERD. We aimed to determine the prevalence of BE in Turkey, which is geographically located between Europe and Asia, and to investigate the frequency of BE according to the degree of anatomical disruption in the EGJ. This prospective study was performed on 1000 consecutive patients referred for endoscopy for any clinical indication. All patients underwent a structured interview that assessed major symptoms of GERD (regurgitation and heartburn). BE was diagnosed when specialized intestinal metaplasia was detected histologically in the esophageal biopsy specimens. Endoscopically assessed integrity of the EGJ was classied as one of three types, as follows: 1 Normal EGJ. The endoscope shaft was gripped tightly by the cardia in retroexed endoscopy, or it was gripped less tightly but the cardia was seen to open and close with respiration. 2 Widened EGJ. The cardia was open during all phases of respiration in retroexed endoscopy, but there was no endoscopic evidence of hiatal hernia (HH) on the antegrade view. 3 HH. The axial length from the EGJ to the diaphragmatic hiatus was at least 2 cm. BE was found in 12 patients (1.2%). Normal EGJ was seen in 90.7%of patients, widened EGJ in 4.3%, and HH in 5%. Patients with widened EGJ had a signicantly higher incidence of major reux symptoms and erosive esophagitis compared with those with normal EGJ (P = 0.001). BE was found in 14% of patients with HH and in 0.5% of patients with a normal EGJ (P = 0.001). None of the patients with widened EGJ had BE. In terms of BE frequency, these patients did not differ signicantly from those with normal EGJ (P = 0.793) but did differ signicantly from those with HH (P = 0.014). The prevalence of BE was 1.2% in a Turkish population undergoing endoscopy for any reason. In terms of EGJ integrity, comparison of the groups showed that even in the absence of HH, patients with widening of the EGJ had an increased prevalence of major reux symptoms and erosive esophagitis. However, histologically conrmed BE was not seen among patients with widened EGJ. © 2009 The Authors Journal compilation © 2009, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.