Barrett’s Metaplasia develops in 6% to 14% of individuals with Gastro esophageal reflux. Barrett’s formations are increasing in epidemic proportions for, as yet umnknown, reasons. Approximately 0.5%to1.0% of patients with Barrett’s develop Esophageal cancer. Heartburn frequency and duration, male gender, and white race are major risk factors for developing cancer. Obesity and smoking are weak factors. Survival is determined by the stage depth of the tumor.

Barrett's esophagus is the most common cell alteration leading to cancer in the upper gastrointestinal tract (esophagus). This change in the normal esophagus occurs in 10 to 15% of patients with chronic reflux disease (heartburn), and is associated with a 30 to 40x greater risk in developing esophageal cancer. Cancers of the esophagus are increasing at a rate faster than any other cancer in the US. The vast majority of these tumors are occurring in Caucasian males, for reasons that are not yet understood. Factors leading to this will be discussed in the text following.

The most important clinical developments related to Barrett's is the continued accumulation of data that suggest that the increasing incidence of this cancer has reached epidemic proportions. The prevalence of Barrett's esophagus occurs in 10 to 15% of all patients with chronic esophageal reflux(chronic heartburn). Since esophageal reflux (heartburn) occurs in up to 7-17% of the population, it appears that this cell altering process must affect a large number of patients. The average age at the time of diagnosis is 55 years. There is a bimodal age distribution with incidence peaks occurring at 0 to 15 years and at 40 to 80 years. There is a male predominance ranging from 3-4:1, and there is a much higher incidence in whites when compared to blacks (10-20:1). These gender, age, and race characteristics parallel the demographics of esophageal cancer of the gastroesophageal junction. In patients who have been thoroughly evaluated and shown to have no dysphasia, estimates of the incidence of esophageal adenocarcinoma varies ranging from 1 in 48 to 1 in 441 patients years of follow-up. While these rates appear uncommon, several studies have shown that surveillance for adenocarcinoma in patients with Barrett's is at least as cost effective as other, well accepted surveillance programs for colorectal cancer or for breast cancer. Because of this, all patients with Barrett’s metaplasia should be in a surveillance program. Doctors at the Drexel University College of Medicine are working to confirm earlier observations that the use of molecular biology techniques may enhance the accuracy and efficiency of surveillance techniques.