# Diagnostic Accuracy and Histopathological Correlation of Suspected Barrett’s Esophagus in Patients Undergoing Endoscopy for Dyspeptic Symptoms: A Retrospective Cross-Sectional Study

## TL;DR

This study finds that endoscopy alone overestimates Barrett’s esophagus cases, highlighting the need for histological confirmation and targeted screening.

## Contribution

The study identifies key predictors of histologically confirmed Barrett’s esophagus and highlights the overestimation by endoscopic suspicion.

## Key findings

- Endoscopic suspicion overestimates Barrett’s esophagus prevalence, with only 50.4% confirmation via biopsy.
- Age ≥50, male sex, hiatal hernia, and absence of H. pylori are independent predictors of confirmed Barrett’s esophagus.
- H. pylori prevalence is significantly lower in Barrett’s esophagus patients compared to non-BE patients.

## Abstract

Barrett’s esophagus (BE) is a premalignant condition resulting from chronic gastroesophageal reflux disease (GERD), associated with increased risk of esophageal adenocarcinoma. Endoscopic identification of BE remains imperfect without histological confirmation. This study evaluates the diagnostic accuracy of endoscopy in detecting BE and identifies its associated factors using data from a large cohort of dyspeptic patients.

In this retrospective study, we reviewed 41,268 adults undergoing upper gastrointestinal endoscopy for dyspeptic symptoms between 2014 and 2018. Among them, 840 had suspected BE. Biopsies were obtained per the Seattle protocol and assessed for intestinal metaplasia by expert pathologists. Clinical and endoscopic features and Helicobacter pylori status were analyzed.

Histological confirmation was achieved in 423 of 840 patients (50.4%). Short-segment BE comprised 97.4% of cases. Multivariate analysis identified age≥50 years, male sex, presence of hiatal hernia, and absence of H. pylori as independent predictors of histologically confirmed BE (P<0.05 for all). H. pylori prevalence was significantly lower in BE patients (26.2%) compared to non-BE patients (47.7%).

Endoscopic suspicion alone significantly overestimates BE prevalence, particularly for short-segment BE. Systematic biopsies remain essential for accurate diagnosis. The inverse association between H. pylori and BE suggests that H. pylori infection may be linked with a lower prevalence of BE. Targeted screening strategies are needed, especially in high-risk populations.