Barrett's esophagus in 2008: an update.
With the rising incidence and overall poor prognosis of esophageal adenocarcinoma (EA) there is great interest in furthering our understanding of Barrett's esophagus, the precursor lesion for most cases of EA. The best available evidence from true population-based analysis suggests that the prevalence of Barrett's is 1.6%. In addition, nearly half of the patients with Barrett's are asymptomatic. Several risk factors for development of Barrett's have been identified including gastro-esophageal reflux disease (GERD), central obesity, H. pylori eradication, and male gender. The precise incidence of progression from Barrett's to esophageal adenocarcinoma is not known, but it probably is less than 0.5% per year, and our ability to predict who is at highest risk for progression remains poor. The degree of dysplasia is currently used as a marker for risk of progression to cancer though there is increasing evidence that biomarkers and level of genetic instability may provide better predictive measures. Intensive acid-suppression and COX-2 inhibition are potential strategies to reduce the risk of progression, though definitive studies are needed. Endoscopic surveillance remains the mainstay of management for non-dysplastic and low grade dysplasia Barrett's. The advent of various endoscopic ablative therapies has provided a promising alternative to surgery for Barrett's patients with high grade dysplasia (HGD).
Division of Gastroenterology, Department of Medicine and Center for Clinical Epidemiology and Biostatistics University of Pennsylvania School of Medicine, Pennsylvania 19104-6021, USA.
Richard K
RK
Wood
Yu-Xiao
YX
Yang
D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D014408:Biomarkers, Tumor; D016861:Cyclooxygenase Inhibitors / Q000494:pharmacology; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000150:complications / Q000209:etiology; D004947:Esophagus / Q000473:pathology; D005260:Female; D005762:Gastroenterology / Q000379:methods / Q000639:trends; D016481:Helicobacter Infections / Q000150:complications* / Q000628:therapy; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications; D012307:Risk Factors; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D016861:Cyclooxygenase Inhibitors