African Americans Have Reduced Risk of Long and Short-Segment Barrett’s Esophagus Compared to Non-Hispanic Whites: A Meta-Analysis

Introduction: African Americans (AA) have a decreased prevalence of Barrett’s esophagus (BE) compared to non-Hispanic Whites (nHw). However, the difference in long-segment (LSBE) or short-segment BE (SSBE) prevalence between AA and nHw has not been determined to date. The study aim was to estimate the odds ratios for histologic LSBE or SSBE between nHw and AA across the available studies. Methods: Publication search in the Medline and Embase databases from 1999 to 2025 was performed. Included studies had histologically confirmed BE and classified it as LSBE or SSBE. Each study was weighted according to its inverse variance. Effect distribution measures were examined using visual and tabular displays as well as tests of homogeneity to reveal risk estimate variation of histologic BE occurrence between AA and nHw using a DerSimonian-Laird random-effects method. Odds ratio was calculated along with 95% confidence intervals. Forest plots were conducted, and a summary odds ratio with 95% CI of histologic BE was reported. Heterogeneity was quantified using the I 2 statistic. A sensitivity analysis was performed comparing results with and without case-control studies. Results: Three eligible studies reported histologic confirmation of LSBE and SSBE in AA and nHw. When pooled, the odds of developing LSBE were 0.095 (95% CI, 0.05-0.15) and 0.31 (95% CI, 0.27-0.34) for SSBE in AA compared to nHw. Conclusions: AA patients have lower odds of developing LSBE and SSBE compared to nHw. Further studies are required to determine the clinical implications and progression to EAC.