title: Review on the annual cancer risk of Barrett's esophagus in persons with symptoms of gastroesophageal reflux disease.
abstract: BACKGROUND
  Esophageal adenocarcinoma results from gastroesophageal reflux and develops along a sequence involving non-dysplastic Barrett's esophagus (NDBE), low- (LGD) and high-grade dysplasia (HGD). We aimed to examine the reported annual cancer risk for NDBE in persons with symptoms of gastroesophageal reflux disease, i.e. symptomatic NDBE.
  
  
  METHODS
  Our study reviewed seven population-based studies and five meta-analyses on the annual cancer risk of symptomatic NDBE published between 2006-2012.
  
  
  RESULTS
  The published annual cancer risk of symptomatic NDBE ranges from 0.12-0.5% and 0.33-0.7% in population-based studies and meta-analyses, respectively. Risk factors for cancer development include male gender, age >60 years, length of endoscopically visible columnar lined esophagus (CLE) >3.0 cm, size of the hiatal hernia, progression to LGD/HGD and past history of cigarette smoking. The mean time-to-cancer development is 5 years and ranges from 2 to 15 years. Age at the diagnosis of symptomatic NDBE and cancer development plateaus around 50 and 60 years of age, respectively. Symptomatic NDBE does not affect the life expectancy, when compared to the general population. The majority of patients with NDBE do not die due to esophageal adenocarcinoma but due to comorbidity (cardiorespiratory, neurological, other cancer). The risk and prognosis of asymptomatic NDBE remains unknown.
  
  
  CONCLUSIONS
  The published annual cancer risk for symptomatic NDBE is low. However, demographic and endoscopic data contribute to define a subgroup of patients with symptomatic NDBE with a cancer risk comparable to LGD, where elimination within controlled trials seems justified (radiofrequency ablation). Future efforts should extend towards asymptomatic NDBE, the major cause for cancer development.
authors.affiliation: University Clinic of Surgery, Comprehensive Cancer Center Vienna Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Lenglinger
authors.forename: Martin
authors.initials: M
authors.lastname: Riegler
authors.forename: Enrico
authors.initials: E
authors.lastname: Cosentini
authors.forename: Reza
authors.initials: R
authors.lastname: Asari
authors.forename: Ildiko
authors.initials: I
authors.lastname: Mesteri
authors.forename: Fritz
authors.initials: F
authors.lastname: Wrba
authors.forename: Sebastian F
authors.initials: SF
authors.lastname: Schoppmann
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology; D001471:Barrett Esophagus / Q000453:epidemiology*; D004938:Esophageal Neoplasms / Q000453:epidemiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology*; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors