History and exam

Key diagnostic factors

common

heartburn

Typical symptom of GERD, the presence of which is essential for the development of Barrett esophagus.

regurgitation

Typical symptom of GERD, the presence of which is essential for the development of Barrett esophagus.

uncommon

dysphagia

May indicate stricture (benign or malignant) or esophageal motility disorders.

Other diagnostic factors

uncommon

incidental finding during gastrointestinal endoscopy for other indication

Barrett esophagus may be asymptomatic and detected incidentally during endoscopy for another indication.

chest pain

Atypical GERD symptom.

laryngitis

Atypical GERD symptom.

cough

Atypical GERD symptom.

dyspnea or wheezing

Reflux-induced asthma or reactive airway disease are atypical manifestations of GERD.

history of aspiration pneumonia

Atypical manifestation of GERD.

Risk factors

strong

acid/bile reflux or GERD

Barrett esophagus does not develop in the absence of reflux. Both epidemiologic and molecular biologic evidence supports this association.[2][3][4][12][13][19][23] A meta-analysis of 26 studies found that the presence of GERD-related symptoms increased the risk of long-segment Barrett esophagus fivefold, but seemed to have little association with short-segment Barrett esophagus. However, it was noted that the study results were quite heterogeneous.[24]

increased age

In general, increased age is associated with an increased prevalence of Barrett esophagus.[6]​[10][23]​​[25]​​​

white ethnicity

The majority of cases are found in white patients.[10][23]

male sex

Men have an almost twofold increased risk as compared with women.[6][8]​​​​​[11]​​[23]​[26]​

weak

family history of Barrett esophagus or esophageal adenocarcinoma

A risk factor for a minority of patients. Of those with Barrett esophagus, esophageal adenocarcinoma, or gastroesophageal junction adenocarcinoma, 7.3% will have at least one first or second degree relative with Barrett esophagus. Specifically, 6.2% of patients with Barrett esophagus, 9.5% of patients with esophageal adenocarcinoma, and 9.5% of patients with gastroesophageal junction adenocarcinoma will have such a relation.[27]

obesity

Obesity has been shown to increase the odds ratio of harboring Barrett esophagus.[23][28][29]

smoking

Prevalence of Barrett esophagus among smokers is higher than in nonsmokers, but is mainly related to the increased prevalence of GERD in the former group.[6]​[30]​​

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