National differences in the prevalence of Barrett’s esophagus (BE)
have been described, but it is not clear whether these differences are
real (due to differences in genetic or environmental factors) or spurious
(due to national differences in endoscopic landmarks used by physicians
to identify BE, in endoscopic biopsy protocols, or in histological criteria for BE).
Although BE is widely regarded as rare in Asia, there is wide variation
in the reported prevalence of BE in Asian countries (range 0.06% to 19.9%)
for reasons that remain unclear.
We hypothesized that using a U.S. national database containing patients
of different ethnicities who had endoscopy performed in the United States
— with esophageal biopsies evaluated by a group of gastrointestinal
pathologists in the United States — would minimize confounding due
to national differences in physician factors relating to the diagnosis of BE.
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