Barrett esophagus: will effective treatment prevent the risk of progression to esophageal adenocarcinoma?
Barrett esophagus is a complication of long-standing gastroesophageal reflux disease (GERD) and is the well-recognized premalignant condition for the majority of esophageal and gastroesophageal junction adenocarcinomas. Although duration of gastroesophageal reflux (GER), male sex, and, possibly, a strong family history are directly related to risk of Barrett esophagus, the role of screening in those with GERD and surveillance in those with confirmed Barrett syndrome remains controversial. Acid suppression with proton pump inhibitor (PPI) therapy plays a pivotal role in the management of symptoms in persons with chronic GER and Barrett esophagus. Although there is no conclusive evidence for the role of PPIs in regression of Barrett epithelium or prevention of dysplasia, longer-term studies that titrate the dose to normalization of esophageal pH may proffer different data in the future. Although highly touted in the literature, surgical and endoscopic ablation therapies are limited by several factors, including high rates of symptom recurrence, persistently abnormal pH values, need for repeat surgery, and, in the case of endoscopic therapy, residual Barrett metaplasia that can progress to high-grade dysplasia or cancer. These invasive interventions should only be considered after consultation with a gastroenterologist. Cancer chemoprevention strategies are just emerging, and their roles as direct chemoprotectants remain to be determined.
University of Kansas School of Medicine and the Veterans Administration Medical Center, Kansas City, Missouri 64128, USA.
Prateek
P
Sharma
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D001471:Barrett Esophagus / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D004945:Esophagoscopy; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D011230:Precancerous Conditions / Q000473:pathology*; D011322:Primary Prevention / Q000379:methods; D011379:Prognosis; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000627:therapeutic use; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors; D017494:Proton Pumps