Is Barrett's esophagus an over-hyped disease in the West, and an underdiagnosed disease in the East?

Khek-Yu Ho
Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society 2013, 25 Suppl 2: 157-61
Despite the widespread practice of endoscopic surveillance for Barrett's esophagus in the West, this strategy has not been shown to reduce mortality from esophageal adenocarcinoma. Coupled with the very low absolute annual risk of Barrett's adenocarcinoma of 0.1%, this has called into question as to whether Barrett's esophagus is an over-hyped condition in the West. On the contrary, it is widely assumed that the prevalence of Barrett's esophagus is low in Asia. Could there be under-recognition of Barrett's esophagus, resulting in the underdiagnosis of the disease in the region? Our own study noted a much higher prevalence of histologically confirmed Barrett's esophagus following increased interest in endoscopic investigation of this disease, suggesting the low prevalence of Barrett's esophagus reported in most parts of Asia could have been attributed, at least in part, to underdiagnosis and/or lack of awareness of the condition. Training in the use of standardized diagnostic criteria could enhance diagnosis of the disease. In a recent study conducted by the Asia-Pacific Barrett's Consortium, formal training in the endoscopic recognition of columnar-lined Barrett's segment enhanced endoscopists' detection of the disease and led to significantly higher diagnostic yield (1.5% vs 0.42% in untrained endoscopists). The use of advanced endoscopic imaging technology such as narrow-band imaging improved the negative predictive value in the diagnosis of Barrett's esophagus's associated neoplasia. Raman spectroscopy, a novel biomolecular probe-based technology that does not rely upon operator's interpretation of images, could potentially enhance the detection of Barrett's esophagus and associated neoplasia.


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