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nasdaq
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Quote nasdaq Replybullet Topic: Prevalence of Barrett - General Population
    Posted: 27 Apr 2019 at 7:43am
Hello,

can you tell me why this article talks a about such a "high" prevalence of Barrett - 1,5% Long, 5 % short and 14% ultrashort Barrett.

I always thought only 1% of us have a Barrett ( in sum - > long, Short and very short )

Link

Best Michael

Edited by nasdaq - 27 Apr 2019 at 7:44am
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chrisrob
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Quote chrisrob Replybullet Posted: 27 Apr 2019 at 11:03am
Hi Michael, it does look confusing. Long time since I read this paper and will need to look at it again.

We don't know how many people have Barrett's in UK. The latest thoughts are it could be as many as 3 million.
A few years ago, many people were guessing there could be about 750,000. When I suggested it could be 1 million (based on suggested numbers in US), Cancer Research UK agreed. Then I looked at relative incidence rates of adenocarcinoma in UK and US compared to population size which showed UK rates were 2.5 times those of US, suggesting the figure should actually be 2.5 million. Then Mayo clinic in US, looking at research findings suggested 1 in 20 of the general population have Barrett's - which would give > 3 million in UK (a figure I'm happy to accept unless shown otherwise).

It has actually been suggested that everyone has a few Barrett's cells in their lower oesophagus lying dormant but ready to proliferate as needed. "An alternative explanation derives from the discovery of a discrete population of residual embryonic cells (RECs) existing at the gastroesophageal junction in normal individuals that expands and colonizes regions of the esophagus denuded by chronic reflux." (from The Cellular Origin of Barrett's Esophagus and Its Stem Cells recently published.)

Regarding the relative risks of length of lesion, these two recently published papers may be of relevance:
Significantly lower annual rates of neoplastic progression in short- compared to long-segment non-dysplastic Barrett's esophagus: a systematic review and meta-analysis
External validation of a model to determine risk of progression of Barrett’s oesophagus to neoplasia.

There are obviously considerably more people walking around with Barrett's than know it. That's why we try to raise awareness that anyone with frequent acid reflux should see their doctor. Those of us who know we have Barrett's will receive regular surveillance to spot pre-cancerous changes in time to treat.
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Quote nasdaq Replybullet Posted: 30 Apr 2019 at 12:45pm
Hi Chris, thank you for the informative links - very interesting.

What I don´t understand is that there are so many discrepancy between articles on this topic e.g. - your links about --Regarding the relative risks of length of lesion, these two recently published papers may be of relevance--

and why the always mention the combined endpoint HGD/EAC ... what does this statistic calculation tell us?

Best Michael

For me also interesting are articles where we can see clearly the benefit from barrett surveillance - do you know some or do you have some facts?

Edited by nasdaq - 30 Apr 2019 at 12:46pm
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Quote chrisrob Replybullet Posted: 30 Apr 2019 at 1:32pm
It is always difficult to get reasonable statistics. Unless we were able to scope the entire population or a very significant sample, and follow them to their eventual deaths, we cannot know how many have Barrett's or its ultimate progression risks, and, having no symptoms of its own, makes the job even more difficult.

Regarding surveillance also, it's difficult to quantify - especially since the vast majority of scopes do not show any changes. (In fact, it's suggested we scope too much!)

This paper, Surveillance and survival in Barrett's adenocarcinomas: a population-based study from 2002, concludes,
"Surveillance-detected BE-associated adenocarcinomas were associated with low-stage disease and improved survival. Additional studies are needed to evaluate potential biases and whether screening/surveillance programs decrease mortality among all patients in surveillance. Few patients (3.9%) had a BE diagnosed before their cancer. Thus, even if current surveillance techniques are effective, they are unlikely to substantially impact the population's mortality from esophageal cancer; better methods are needed to identify at risk patients."

and this paper from the same year,
Long-term survival after esophagectomy for Barrett's adenocarcinoma in endoscopically surveyed and nonsurveyed patients, concluded, "Surveillance endoscopy permits early diagnosis of adenocarcinoma in patients with Barrett's esophagus and contributes substantially to long-term survival."

This more recent (2012) paper, Predictors of Progression in Barrett’s Esophagus: Current Knowledge and Future Directions cites the above two studies saying, "This evidence from retrospective studies found that patients diagnosed with EAC in BE surveillance programs may have better survival than those diagnosed after the onset of symptoms has led to recommendations for the endoscopic surveillance of patients diagnosed with BE to detect progression to dysplasia and / or EAC."

I think what we can safely say is it's not an exact science and will continue discussions for years to come. Meanwhile, we just have to work with the best evidence we have.
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Quote nasdaq Replybullet Posted: 30 Apr 2019 at 1:44pm
Thank you Chris !
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