The influence of Helicobacter pylori on the ethnic distribution of Barrett's metaplasia

Background: Environmental risk factors associated with ethnicity may contribute to the occurrence of Barrett's metaplasia. Aim: To investigate the interaction between ethnicity and Helicobacter pylori infection in the occurrence of Barrett's metaplasia among patients undergoing oesophago-gastro-duodenoscopy. Methods: The Miraca Life Sciences Database is an electronic repository of histopathological patient records. A case–control study evaluated the influence of age, gender, ethnicity and histological diagnosis of H. pylori on the occurrence of Barrett's metaplasia. Results: The total study population comprised 596 479 subjects, of whom 76 475 harboured a diagnosis of Barrett's metaplasia. Male sex, age and H. pylori infection in declining order exerted the strongest influence on the occurrence of BM. In comparison with the population comprising Caucasians and African Americans, Barrett's metaplasia was less common among subjects of African (OR = 0.09, 95% CI = 0.01–0.43), Middle Eastern (0.26, 0.20–0.34), East Asian (0.35, 0.31–0.40), Indian (0.39, 0.32–0.47), Hispanic (0.62, 0.59–0.64) or Jewish descent (0.50, 0.45–0.54), but more common among subjects of Northern European descent (1.14, 1.03–1.26). With the exception of Jews and Northern Europeans, all other ethnic subgroups were characterised by a higher prevalence of H. pylori than the comparison group. A low prevalence of H. pylori was significantly associated with a high prevalence of Barrett's metaplasia (R² = 0.82, P < 0.001), as well as dysplasia or oesophageal adenocarcinoma (R² = 0.81, P < 0.001). Conclusion: Our analysis reveals an inverse relationship between the prevalence of Barrett's metaplasia and H. pylori gastritis among different ethnic groups within the United States.