Introduction Oesophageal adenocarcinoma (OAC) incidence rates have increased dramatically in recent decades, particularly among white males in Western societies.1 There appears to be a concurrent rise in Barrett's oesophagus (BO) incidence, the pre-cursor condition for OAC, although it is debated whether this is a true rise, or a reflection of changes in endoscopy practices together with improvement in disease recognition.2 The aim of our investigation was to assess BO incidence over a 13-year period using a population-based register in Northern Ireland.

Methods The Northern Ireland Barrett's oesophagus Register (NIBR) is a population-based register of all adults diagnosed with BO, defined as columnar epithelium of the oesophagus, in Northern Ireland between 1993 and 2005. Data on all upper gastro-intestinal endoscopies and oesophageal biopsies performed in Northern Ireland were obtained from healthcare providers. Annual BO incidence rates were calculated per 100 000 of the population, per 100 endoscopies and per 100 oesophageal biopsies performed.

Results During the 13-year period, 197 635 patients underwent an endoscopy and 9390 of these were diagnosed with BO, of whom 58% were male. Average annual BO incidence rates over this time period are presented in Abstract 072. A 2.5-fold increase in BO incidence in the population was observed. Over the same time, there were 1.3 and 1.6-fold increases in endoscopy and biopsy rates in the population, respectively. Even with the increasing rates of endoscopy and biopsy, BO was still diagnosed more frequently per 100 endoscopies and per 100 biopsies.

Conclusion These findings demonstrate that BO incidence rates in Northern Ireland have increased more rapidly than the rate of endoscopies or biopsies. This could indicate that a true rise in BO incidence has occurred, contributing to the increase in OAC seen in Western populations. This may have implications for efforts to prevent OAC.