Barrett’s esophagus: results from an Italian cohort with tight endoscopic surveillance: Barrett’s Esophagus: an Italian cohort

Barrett’s esophagus: results from an Italian cohort with tight endoscopic surveillance

Barrett’s Esophagus: an Italian cohort


  • Kryssia Rodriguez-Castro
  • Pellegrino Crafa Department of Medicine and Surgery, University of Parma
  • Marilisa Franceschi
  • Lorella Franzoni
  • Lorenzo Brozzi
  • Antonio Ferronato
  • Alice Morini
  • Lucio Cuoco
  • Gianluca Baldassarre
  • Barbara Pertoldi
  • Francesco Di Mario


Barrett’s Esophagus;, esophageal adenocarcinoma;, gastroesophageal reflux disease


Background and aim: Barrett’s Esophagus represents a condition that predisposes to the development of esophageal adenocarcinoma. The aim of the present study was to analyze the demographic and clinical characteristics of patients with BE, to establish the presence of risk factors for this condition, and to determine the frequency of dysplastic lesions as well as the evolution towards adenocarcinoma under tight endoscopic control.

Methods: In this study, we retrospectively collected and analyzed data from a cohort of patients with Barrett’s Esophagus identified through endoscopic records of ULSS7 in Northern Italy, who underwent upper esophagogastroduodenoscopy over a 10-year period from July 2008 to December 2020.

Results: A total of 264 patients were identified as having BE and included in the study. Mean follow-up was 6.7 years (range: 3 months-13 years). Demographic characteristics of the study population included mean age of 62.7 years (range 33-90 years), with 62.5% of the study population being aged 60 or older, and a male predominance. Females were significantly older than males (65.7 years, range 37-90 vs 61.9 years, range 33-87, p=0.043, respectively).

Conclusions: The present study confirms the importance of tight endoscopic control in the management of BE, favoring early detection of BE degeneration towards high-grade dysplasia or adenocarcinoma. In a subset of patients with high-risk factors including male sex, cigarette smoking and heavy alcohol intake, it may be worthwhile to consider endoscopic control over time in order to detect the development of BE.


Vakil N., van Zanten S.V., Kahrilas P., Dent J., Jones R. and the Global Consensus Group “The Montreal definition and classification of gastroesophageal reflux disease: A global evidence-based consensus,” Am J Gastroenterol; 2006; 101(8):1900-20.

Shaheen N. J., Crosby M. A., Bozymski E. M., Sandler R. S., “Is there publication bias in the reporting of cancer risk in Barrett’s esophagus?,” Gastroenterology, 2000; 119(2):333–338

Hvid-Jensen F., Pedersen L., Drewes A. M., Sørensen H. T.,Funch-Jensen P., “Incidence of Adenocarcinoma among Patients with Barrett’s Esophagus,” N. Engl. J. Med., 2011;365(15):1375–1383

Chang E.Y. Morris C.D., Seltman A.K. et al., “The effect of antireflux surgery on esophageal carcinogenesis in patients with barrett esophagus: A systematic review,” Ann Surg. 2007;246(1):11-21.

Yousef F., Cardwell C., Cantwell M. M., Galway K., Johnston B. T., Murray L., “The incidence of esophageal cancer and high-grade dysplasia in Barrett’s esophagus: A systematic review and meta-analysis,” Am J Epidemiol. 2008;168(3):237-49

Sikkema M., de Jonge P. J. F., Steyerberg E. W., Kuipers E. J., “Risk of Esophageal Adenocarcinoma and Mortality in Patients With Barrett’s Esophagus: A Systematic Review and Meta-analysis,” Clin Gastroenterol Hepatol. 2010;8(3):235-44

Thomas T., Abrams K. R., De Caestecker J. S., Robinson R. J., “Meta analysis: Cancer risk in Barrett’s oesophagus,” Aliment Pharmacol Ther. 2007;26(11-12):1465-77

Spechler S. J., “Barrett esophagus and risk of esophageal cancer: A clinical review,” JAMA. 2013;310(6):627-36

Wild C. P., Hardie L. J.,“Reflux, Barrett’s oesophagus and adenocarcinoma: Burning questions,” Nat Rev Cancer. 2003;3(9):676-84.

Cameron A. J., Zinsmeister A. R., Ballard D. J., Carney J. A., “Prevalence of columnar-lined (Barrett’s) esophagus. Comparison of population-based clinical and autopsy findings,” Gastroenterology. 1990;99(4):918-22

Zagari R. M., Fuccio l., Wallander M.A. et al., “Gastro-oesophageal reflux symptoms, oesophagitis and Barrett’s oesophagus in the general population: The Loiano-Monghidoro study,” Gut. 2008;57(10):1354-9

Qumseya B. J., Bukannan A., Gendy S. et al., “Systematic review and meta-analysis of prevalence and risk factors for Barrett’s esophagus,” Gastrointest Endosc. 2019;90(5):707-717.e1.

Eusebi L. H., Ratnakumaran R., Yuan Y., Solaymani-Dodaran M., Bazzoli F., Ford A. C., “Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: A meta-analysis,” Gut. 2018;67(3):430-440.

Steevens J., Schouten L.J., Driessen A.L.C. et al., “A prospective cohort study on overweight, smoking, alcohol consumption, and risk of Barrett’s esophagus,” Cancer Epidemiol Biomarkers Prev. 2011 Feb;20(2):345-58

Eusebi L. H., Fuccio L., Bazzoli F., “The role of obesity in gastroesophageal reflux disease and Barrett’s esophagus,” Dig Dis. 2012;30(2):154-7

Parasa S., Vennalaganti S., Gaddam S. et al., “Development and Validation of a Model to Determine Risk of Progression of Barrett’s Esophagus to Neoplasia,” Gastroenterology. 2018;154(5):1282-1289.e2.

M. Rugge, Meggio A., Pennelli G. et al., “Gastritis staging in clinical practice: The OLGA staging system,” Gut. 2007;56(5):631-6

Pohl H, Pech O, Arash H, Stolte M, Manner H, May A, et al. Length of Barrett’s oesophagus and cancer risk: Implications from a large sample of patients with early oesophageal adenocarcinoma. Gut. 2016; 65(2):196–201.

Brown CS, Lapin B, Wang C, Goldstein JL, Linn JG, Denham W, et al. Predicting regression of Barrett’s esophagus: results from a retrospective cohort of 1342 patients. Surg Endosc. 2014; 28(10):2803–7.

Filiberti R, Fontana V, De Ceglie A, Blanchi S, Grossi E, Della Casa D, et al. Smoking as an independent determinant of Barrett’s esophagus and, to a lesser degree, of reflux esophagitis. Cancer Causes Control. 2015; 26(3):419–29.

Balasubramanian G, Gupta N, Giacchino M, Singh M, Kanakadandi V, Gaddam S, et al. Cigarette smoking is a modifiable risk factor for Barrett’s oesophagus. United Eur Gastroenterol J. 2013; 1(6):430–7.

Butorion N, Bichurina T, Tsukanov V, Kasparov E, Kuklin D, Timoshenko V, et al. The prevalence and clinical aspects of Barrett’s esophagus in the population of Eastern Siberia. Ter Arkh. 2013; 85(1):62–5.

Ren LL, Yan TT, Wang ZH, Bian ZL, Yang F, Hong J, et al. Alcohol consumption and the risk of Barrett’s esophagus: A comprehensive meta-analysis. Sci Rep. 2015 Nov 6;5:16048.

Masuda A, Fujita T, Murakami M, Yamazaki Y, Kobayashi M, Terao S, et al. Influence of hiatal hernia and male sex on the relationship between alcohol intake and occurrence of Barrett’s esophagus. PLoS One. 2018; 13(2).

Peng S, Cui Y, Xiao YL, Xiong LS, Hu PJ, Li CJ, et al. Prevalence of erosive esophagitis and Barretts esophagus in the adult Chinese population. Endoscopy. 2009;41(12):1011–7.

Anderson LA, Murphy SJ, Johnston BT, Watson RGP, Ferguson HR, Bamford KB, et al. Relationship between Helicobacter pylori infection and gastric atrophy and the stages of the oesophageal inflammation, metaplasia, adenocarcinoma sequence: Results from the FINBAR case-control study. Gut. 2008; 57(6):734–9.

Doorakkers E, Lagergren J, Santoni G, Engstrand L, Brusselaers N. Helicobacter pylori eradication treatment and the risk of Barrett’s esophagus and esophageal adenocarcinoma. Helicobacter. 2020;25(3):e12688.

Erőss B, Farkas N, Vincze Á, Tinusz B, Szapáry L, Garami A, et al. Helicobacter pylori infection reduces the risk of Barrett’s esophagus: A meta-analysis and systematic review. Helicobacter. 2018; 23(4):e12504.

Crafa P, Franceschi M, Castro KIR, Barchi A, Russo M, Franzoni L, et al. Functional dyspesia. Acta Biomed. 2020 Sep 11;91(3):1–7.

Jochem V, Fuerst P, Fromkes J. Familial Barrett’s esophagus associated with adenocarcinoma. Gastroenterology. 1992;102(4):1400–2.

De Ceglie A, Filiberti R, Blanchi S, Fontana V, Fisher DA, Grossi E, et al. History of cancer in first degree relatives of Barrett’s esophagus patients: A case-control study. Clin Res Hepatol Gastroenterol. 2011; 35(12):831–8.

Hemminki K, Czene K. Attributable Risks of Familial Cancer from the Family-Cancer Database. Cancer Epidemiol Biomarkers Prev. 2002;11(12):1638–44.

Hemminki K, Sundquist J, Lorenzo Bermejo J. Familial Risks for Cancer as the Basis for Evidence‐Based Clinical Referral and Counseling. Oncologist. 2008; 13(3):239–47.

Gao Y, Hu N, Han XY, Giffen C, Ding T, Goldstein A, et al. Family history of cancer and risk for esophageal and gastric cancer in Shanxi, China. BMC Cancer. 2009; 9:269.

Keller G, Rotter M, Vogelsang H, Bischoff P, Becker K, Mueller J, et al. Microsatellite instability in adenocarcinomas of the upper gastrointestinal tract. Relation to clinicopathological data and family history. Am J Pathol. 1995;147(3):593–600.

Khalaf N, Ramsey D, Kramer JR, El-Serag HB. Personal and family history of cancer and the risk of Barrett’s esophagus in men. Dis Esophagus. 2015; 28(3):283–90.

Rubenstein JH, Tavakkoli A, Koeppe E, Ulintz P, Inadomi JM, Morgenstern H, et al. Family History of Colorectal or Esophageal Cancer in Barrett’s Esophagus and Potentially Explanatory Genetic Variants. Clin Transl Gastroenterol. 2020; 11(4):e00151.

Andrici J, Tio M, Cox MR, Eslick GD. Hiatal hernia and the risk of Barrett’s esophagus. J Gastroenterol Hepatol. 2013;28(3):415–31.

Kwon JY, Kesler AM, Wolfsen HC, DeVault KR, Kröner PT. Hiatal Hernia Associated with Higher Odds of Dysplasia in Patients with Barrett’s Esophagus. Dig Dis Sci. 2020;

Weston AP, Badr AS, Hassanein RS. Prospective Multivariate Analysis of Factors Predictive of Complete Regression of Barrett’s Esophagus. Am J Gastroenterol. 1999; 94(12):3420–6.

Savarino E V., de Bortoli N, de Cassan C, Della Coletta M, Bartolo O, Furnari M, et al. The natural history of gastro-esophageal reflux disease: A comprehensive review. Dis Esophagus. 2017; 30(2):1-9.

Alicuben ET, Tatum JM, Bildzukewicz N, Samakar K, Samaan JS, Silverstein EN, et al. Regression of intestinal metaplasia following magnetic sphincter augmentation device placement. Surg Endosc. 2019 Feb;33(2):576-579.

Ozmen V, Sen Oran E, Gorgun E, Asoglu O, Igci A, Kecer M, et al. Histologic and clinical outcome after laparoscopic Nissen fundoplication for gastroesophageal reflux disease and Barrett’s esophagus. Surg Endosc Other Interv Tech. 2006; 20(2):226–9.

Simonka Z, Paszt A, Ábrahám S, Pieler J, Tajti J, Tiszlavicz L, et al. The effects of laparoscopic Nissen fundoplication on Barrett’s esophagus: Long-term results. Scand J Gastroenterol. 2012; 47(1):13–21.

Navab F, Nathanson BH, Desilets DJ. The impact of lifestyle on Barrett’s Esophagus: A precursor to esophageal adenocarcinoma. Cancer Epidemiol. 2015; 39(6):885–91.

Barrie J, Yanni F, Sherif M, Dube AK, Tamhankar AP. Length of Barrett’s esophagus in the presence of low-grade dysplasia, high-grade dysplasia, and adenocarcinoma. Surg Endosc. 2020;

Kastelein F, Spaander MCW, Steyerberg EW, Biermann K, Valkhoff VE, Kuipers EJ, et al. Proton pump inhibitors reduce the risk of neoplastic progression in patients with barrett’s esophagus. Clin Gastroenterol Hepatol. 2013; 11(4):382–8.

Nguyen DM, El-Serag HB, Henderson L, Stein D, Bhattacharyya A, Sampliner RE. Medication Usage and the Risk of Neoplasia in Patients With Barrett’s Esophagus. Clin Gastroenterol Hepatol. 2009; 7(12):1299–304.

Hillman LC, Chiragakis L, Shadbolt B, Kaye GL, Clarke AC. Proton-pump inhibitor therapy and the development of dysplasia in patients with Barrett’s oesophagus. Med J Aust. 2004; 180(8):387-91.

Rodriguez-Castro KI, Franceschi M, Noto A, Miraglia C, Nouvenne A, Leandro G, et al. Clinical manifestations of chronic atrophic gastritis. Acta Biomed. 2018 Dec 17;89(8-S):88-92.

Peitz U, Wex T, Vieth M, Stolte M, Willich S, Labenz J, et al. Correlation of serum pepsinogens and gastrin-17 with atrophic gastritis in gastroesophageal reflux patients: A matched-pairs study. J Gastroenterol Hepatol. 2011; 26(1):82–9.

Di Mario F, Cavallaro LG, Moussa AM, Caruana P, Merli R, Maini A, et al. Usefulness of Serum Pepsinogens in Helicobacter pylori Chronic Gastritis: Relationship With Inflammation, Activity, and Density of the Bacterium. Dig Dis Sci. 2006; 51(10):1791–5.

Di Mario F, Crafa P, Franceschi M, Rodriguez-Castro K, Baldassarre G, Ferronato A, et al. Low Levels of Gastrin 17 are Related with Endoscopic Findings of Esophagitis and Typical Symptoms of GERD. J Gastrointestin Liver Dis. 2021; 30(1):25–9.

El-Serag HB, Aguirre T V., Davis S, Kuebeler M, Bhattacharyya A, Sampliner RE. Proton pump inhibitors are associated with reduced incidence of dysplasia in Barrett’s esophagus. Am J Gastroenterol. 2004; 99(10):1877–83.







How to Cite

Rodriguez-Castro K, Crafa P, Franceschi M, Franzoni L, Brozzi L, Ferronato A, et al. Barrett’s esophagus: results from an Italian cohort with tight endoscopic surveillance: Barrett’s Esophagus: an Italian cohort. Acta Biomed [Internet]. 2022 Mar. 14 [cited 2024 Jul. 21];93(1):e2022130. Available from: