Introduction Oesophageal adenocarcinoma (OAC) incidence rates have increased in recent decades, particularly among white males in Western societies. Rising Barrett's oesophagus (BO) incidence, the pre-cursor condition for OAC, may explain this phenomenon. However, increasing BO incidence may also simply reflect changes in endoscopy practices together with improvement in disease recognition. 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 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. Annual BO incidence rates were calculated per 100 000 of the population, per 100 upper gastro-intestinal endoscopies and per 100 oesophageal biopsies performed in Northern Ireland.

Results During the 13-year period, 197 635 patients underwent an endoscopy and 9329 of these were diagnosed with BO. Average annual BO incidence rates rose by 2.5-fold, increasing from 31.9/100 000 during 1993–1997 to 80.1/100 000 during 2002–2005. Over the same time, there were 1.3- and 1.6-fold increases in endoscopy and biopsy rates in the population, respectively. Even with increasing rates of endoscopy and biopsy, BO was still diagnosed more frequently per 100 endoscopies and per 100 biopsies.

Conclusion 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.