Risk Factors for Barrett's Oesophagus in Individuals With Gastro-Oesophageal Reflux Symptoms: A Systematic Review and Meta-Analysis

Background: Gastro-oesophageal reflux symptoms are common in the community and may lead to the development of Barrett’s oesophagus (BO). However, potential risk factors for the development of BO in patients with gastro-oesophageal reflux symptoms are controversial. We performed a systematic review and meta-analysis to examine this issue. Methods: Medline, Embase, and Embase Classic were searched (until October 2020) to identify cross-sectional studies that reported the prevalence of BO based on presence of one or more risk factors (age, non-steroidal anti-inflammatory drug (NSAID) and/or aspirin use, Helicobacter pylori status, hiatal hernia, Body mass index, and tobacco or alcohol consumption) in individuals with gastro-oesophageal reflux symptoms.The prevalence of BO was compared according to presence or absence of each these risk factors in individuals with gastro-oesophageal reflux symptoms using an odds ratio (OR), with a 95% confidence interval (CI). Findings: Of 6593 citations evaluated, 15 studies reported the prevalence of BO in 12,113 subjects. Pooled prevalence of histologically-confirmed BO in individuals with gastro-oesophageal reflux symptom sin all studies was 7.2%(95% CI: 5.1% to 9.6%).Prevalence was significantly higher in subjects with hiatal hernia (OR 2.74; 95% CI 1.58 to 4.75) and in those who drank alcohol (OR 1.51; 95% CI 1.17 to 1.95). Interpretation: The prevalence of BO in individuals with gastro-oesophageal reflux symptoms was significantly higher in those who drank alcohol, although the association was modest. The strongest association found was between hiatal hernia and BO. Most potential risk factors did not appear to be associated with presence of BO, questioning whether they are directly involved in its development. Funding: None. Declaration of Interests:The Authors declare no competing interests. Ethics approval Statement: Not required.