Who gets Barrett's esophagus and could I have it?

Although anyone can have Barrett's esophagus, the typical patient with Barrett's esophagus is a middle-aged or elderly Caucasian (white) man who has a long history of heartburn. Women also develop Barrett's esophagus but men outnumber women by a ratio of around 4 to 1. Up to 8 times as many men develop esophageal adenocarcinoma (Barrett's associated cancer) as women. Barrett's esophagus and esophageal adenocarcinoma are much less common in minority populations. No one knows why Caucasian men are the largest group which develops Barrett's esophagus and thus are the group at greatest risk for developing esophageal adenocarcinoma.

Heartburn (gastroesophageal reflux disease)

Heartburn, or gastroesophageal reflux disease (GERD) is the most important risk factor for Barrett's esophagus. Heartburn is a very common problem in the United States and in other parts of the Western world. Some studies and polls have suggested that anywhere between 38-44% of people have heartburn symptoms at least once per month. It is believed that up to 20% of people have heartburn symptoms at least once per week and that about 7% of people have heartburn at least once per day. Of the 7-20% of people who have more frequent heartburn, it is estimated that about 10% to 15% have Barrett's esophagus and autopsy studies have reported that up to 1 in 80 to 1 in 60 persons may have Barrett's esophagus.

Typical heartburn symptoms include burning in the chest or high abdomen that can move up the chest towards the mouth. This pain usually occurs after meals, at night while in bed, or can be associated with body position, such as bending over. Regurgitation (burping up) of acid (sour tasting liquid) into the mouth is also a typical GERD symptom. Whether or not your heartburn symptoms get better on medication or even if you had heartburn in the past but none in recent years, you can still have Barrett's esophagus. In one recent Swedish study, 44% of patients who had Barrett's esophagus had no heartburn symptoms during the past 3 months. Surprisingly, as many as 40% of patients who are diagnosed with an esophageal adenocarcinoma (Barrett's associated cancer) deny ever having typical heartburn or GERD symptoms, such as burning chest pain or regurgitation of acid. 

Many patients who are diagnosed with Barrett's esophagus have esophageal injury from acid and bile with associated inflammation called esophagitis. Often, a complication or symptom of severe esophagitis, such as vomiting blood, passing black bowel movements, or a stricture (narrowing of the esophagus) with dysphagia (food sticking in the esophagus) leads to the diagnosis of Barrett's esophagus. These are very serious warning signs and anyone  who has these signs should see a doctor immediately. 

Obesity

Obesity or excess weight gain appears to be a strong risk factor for esophageal adenocarcinoma (Barrett's associated cancer) and therefore may be a risk factor for Barrett's esophagus. In men, there is evidence that the risk of developing esophageal adenocarcinoma increases with increasing weight. One recent study also reports that among male veterens studied at a VA hospital, being overweight is associated with a 2.5 times increased risk of having Barrett's esophagus compared to veterans who are not overweight. Although no one knows why increased weight is a risk factor, some have thought that fat deposited around the abdominal area increases pressure on the stomach, especially when lying down. This increased pressure may increase the frequency or number of heartburn episodes. It has been proposed that the trend of increasing weight in the general population, especially in men who tend to deposit fat around the abdominal area, may be one of the reasons why esophageal adenocarcinoma has increased in this country during the past three decades.

Age

Another risk factor for Barrett's esophagus is age. In one study, Barrett's esophagus was detected more often in older patients, the average age was 63. In this study, Barrett's esophagus was two times as likely to be present in a patient in his seventies compared to a patient 40 years of age or less. Others have also reported that age is a risk factor for Barrett's esophagus.

Family history

Not much is known about the influence of family history on the development of Barrett's esophagus. It has been shown that heartburn symptoms and esophagitis (inflammation of the esophagus from reflux of stomach acid and bile) are more common in relatives of patients who have Barrett's esophagus as compared to relatives of patients without Barrett's esophagus There are a few families reported to have some family members with Barrett's esophagus. It is not clear whether it is the tendency to develop GERD or Barrett's esophagus or both that is passed down in these families. One recent study reported that both members of an identical twin pair were more likely to have GERD than both members of a non-identical twin pair. This study supports that GERD is inherited because only identical twins share exactly the same genes (genetic material passed down to them from their mother and father).

Some researchers are trying to answer the question of whether Barrett's esophagus is inherited or passed down in families. One group of researchers performed upper endoscopy to look for Barrett's esophagus in patients who had heartburn and who also had a family member with Barrett's esophagus and then in patients who had heartburn but who did NOT have a family member with Barrett's esophagus. These researchers reported that so far, they have found no significant difference between these two groups of patients. About the same number in each group had Barrett's esophagus detected on upper endoscopy regardless of whether they had family members with Barrett's esophagus.  Another group of researchers reported that family members of patients who had Barrett's esophagus or esophageal adenocarcinoma (Barrett's associated cancer) were more likely to have Barrett's esophagus or esophageal adenocarcinoma compared to family members of patients who had GERD but no Barrett's esophagus. However, as of yet, there is not a large body of evidence that Barrett's esophagus is inherited and most patients who have Barrett's esophagus do not have a known relative with Barrett's esophagus Certainly, anyone who has chronic heartburn symptoms, whether or not they have a close relative with Barrett's esophagus or esophageal adenocarcinoma, could have Barrett's esophagus.

In summary, the typical patient who has Barrett's esophagus is a middle-aged to elderly Caucasian (white) man, mildly to moderately overweight, who has a history of longstanding heartburn. Although esophageal adenocarcinoma has also dramatically increased in white women over the past three decades, the absolute number of women who have Barrett's esophagus and develops esophageal adenocarcinoma remains low. Although this disease occurs much less often in minority populations, it has increased in the African American population during  the past three decades. Barrett's esophagus and Barrett's associated cancer may be inherited in some families, but most patients who have Barrett's esophagus or a Barrett's associated cancer have no known relative with Barrett's esophagus. ANYONE, regardless of race, gender, or family history who has a problem with heartburn now or in the past could have Barrett's esophagus.