Barrett Esophagus

Abstract

ImportanceBarrett esophagus is characterized by the replacement of normal esophageal squamous cell epithelium with columnar metaplasia and affects approximately 5% of people in the US and approximately 1% worldwide. Approximately 3% to 5% of patients with Barrett esophagus will be diagnosed with esophageal adenocarcinoma in their lifetime.ObservationsBarrett esophagus affects approximately 2.3% to 8.3% of people with gastroesophageal reflux disease (GERD) and approximately 1.2% to 5.6% of people without GERD. Characteristics associated with Barrett esophagus include older age (prevalence of approximately 1.1% in individuals older than 50 years compared with 0.3% in those 50 years or younger), male sex, and smoking (prevalence of approximately 12% in people who smoke cigarettes compared with 1.1% in those who do not smoke cigarettes). The histopathology of Barrett esophagus progresses from metaplasia to dysplasia and, without treatment, can progress to adenocarcinoma. People with Barrett esophagus have approximately a 0.2% to 0.5% annual rate of developing esophageal adenocarcinoma. Management of Barrett esophagus primarily consists of acid-suppressive medications to reduce underlying GERD symptoms and surveillance endoscopy every 3 to 5 years. In patients with Barrett esophagus and dysplasia or early cancer, endoscopic therapy consisting of resection and ablation successfully treats 80% to 90% of patients.Conclusions and RelevanceBarrett esophagus affects approximately 5% of people in the US and approximately 1% worldwide and is associated with an increased risk of esophageal adenocarcinoma. First-line therapy for Barrett esophagus consists of proton-pump inhibitors for control of reflux symptoms, but their role in chemoprevention is unclear. Surveillance with upper endoscopy is recommended by practice guidelines to monitor for progression to esophageal adenocarcinoma, but randomized clinical trials are lacking.

Surveillance Endoscopy After Foregut Surgery: Is It Necessary?

“…This screening recommendation can be challenged as a sizable portion of patients with the diagnosis of EAC reports no significant history of GERD symptoms. 78,79 Although the incidence of GERD is high, only a small fraction of these patients will be diagnosed with esophageal cancer in their lifetime. Therefore, most symptomatic patients will never develop esophageal cancer.…”

Computational modeling of locoregional recurrence with spatial structure identifies tissue-specific carcinogenic profiles

“…Barrett's Esophagus (BE) is a notable example where whole genome sequencing found similar mutational events between esophageal adenocarcinoma and non-dysplastic BE (54) thereby suggesting different mutational order (55). Reports that prior diagnosis of BE affords a better prognosis (56) with only about 5% of BE patients developing esophageal adenocarcinoma (57) further strengthens the different order of mutation concept.…”

Editorial: Recent updates in advanced gastrointestinal endoscopy

“…In this focused issue of “ Recent updates in advanced gastrointestinal endoscopy ,” we highlight the role of advanced endoscopic techniques for luminal (first-space) esophagogastric, small intestinal, and colorectal disease states. Prevalent esophageal conditions, such as chronic gastroesophageal reflux disease (GERD), can predispose to Barrett's esophagus related neoplasia (BERN) ( 1 ). Early BERN detection with high-resolution endoscopy (chromoendoscopy, narrow-band imaging [NBI], autofluorescence, confocal laser endomicroscopy [CLE]) has revolutionized the field with a significant impact on morbidity and mortality.…”