Epidemiology and natural history of intestinal metaplasia of the gastroesophageal junction and barrett's esophagus: A population-based study

Kee Wook Jung, Nicholas J. Talley, Yvonne Romero, David A. Katzka, Cathy D. Schleck, Alan R. Zinsmeister, Kelly T. Dunagan, Lori S. Lutzke, Tsung Teh Wu, Kenneth K. Wang, Mary Frederickson, Debra M. Geno, G. Richard Locke, Ganapathy A. Prasad

Research output: Contribution to journalArticlepeer-review

120 Scopus citations


Objectives: Population-based data on the epidemiology and outcomes of subjects with intestinal metaplasia of the gastroesophageal junction (IMGEJ) and Barrett's esophagus (BE) are limited. The objectives of this study were to (i) estimate the incidence of IMGEJ and BE diagnosed from clinically indicated endoscopy in Olmsted County, MN, over three decades (1976-2006) and prevalence as of 1 January 2007, (ii) compare baseline characteristics of subjects with IMGEJ and BE, and (iii) study the natural history and survival of both cohorts. Methods: This was a population-based cohort study. The study setting was Olmsted County, MN. Patients with BE (columnar segment 1 cm with intestinal metaplasia) and IMGEJ (intestinal metaplasia in biopsies from the gastroesophageal junction) from 1976 to 2006 in Olmsted County, MN, were identified using Rochester Epidemiology Project resources. Demographic and clinical data were abstracted from medical records and pathology confirmed by gastrointestinal pathologists. The association of baseline characteristics with overall and progression-free survival was assessed using proportional hazards regression models. Outcome measures were baseline characteristics and overall survival of subjects with IMGEJ compared to those with BE. Results: In all, 487 patients (401 with BE and 86 with IMGEJ) were identified and followed for a median interval of 7 (BE subjects) to 8 (IMGEJ subjects) years. Subjects with BE were older, heavier, reported reflux symptoms more often, and had higher prevalence of advanced neoplasia than those with IMGEJ. No patient with IMGEJ progressed to esophageal adenocarcinoma (EAC) in contrast to BE subjects who had a cumulative risk of progression of 7% at 10 years and increased risk of death from EAC (standardized mortality ratio 9.62). The overall survival of subjects with BE and IMGEJ did not differ from that expected in similar age-and sex-distributed white Minnesota populations. Conclusions: Subjects with IMGEJ appear to have distinct clinical characteristics and substantially lower cancer progression risk compared to those with BE.

Original languageEnglish (US)
Pages (from-to)1447-1455
Number of pages9
JournalAmerican Journal of Gastroenterology
Issue number8
StatePublished - Aug 2011

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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