Natural History of Barrett’s Esophagus

Abstract

Barrett’s esophagus (BE) is a very common condition. We have obtained fairly profound knowledge of the natural history of this condition. This results from many cross-sectional and cohort studies, many describing patients undergoing long-term surveillance. Their consent to use their clinical data has improved our knowledge to the benefit of these same and other patients. The prevalence of BE increases with age both in men and in women. This increase starts at a younger age in men than in women. The incidence of high-grade dysplasia and cancer in BE depends on segment length, gender, and age. The latter two likely indicate the duration of the presence of BE in an individual patient. Other factors that influence the incidence of dysplasia and cancer are smoking behavior and use of certain medications such as PPIs, statins, and NSAIDs. Surveillance of BE and treatment of dysplasia can impact the incidence of and mortality due to esophageal adenocarcinoma. This is of major benefit to a subgroup of BE patients. The epidemiology and burden of disease ask for further efforts to develop targeted screening, surveillance, and intervention techniques in coming years.

Gastroesophageal reflux disease, Barrett esophagus, and esophageal adenocarcinoma – where do we stand?

“…Almost 25% of all human cancers are located in the gastrointestinal tract (GIT), making it the dominant cancer-affected site. The reason for this could be constant GIT exposure to organ damage and chronic inflammation ( 1 ). Despite all medical breakthroughs, less than half of patients survive one year after the esophageal adenocarcinoma (EAC) diagnosis ( 2 ).…”

“…Premalignant condition for EAC development is Barrett esophagus (BE), a disorder characterized by abnormal transformation of the squamous epithelium. BE is strongly associated with prolonged gastro-esophageal reflux of gastric and bile acids ( 1 , 3 , 4 ). Since patients with BE carry 30-40 times higher risk for EAC than general population, it is not surprising that in the last 10-20 years the research interest in BE has been growing ( 3 ).…”

HER2 Heterogeneity in Personalized Therapy of Gastro-Oesophageal Malignancies: An Overview by Different Methodologies

“…Nevertheless, some discrepancies between Japanese and European/North American pathologists are emerged in order to categorize GD; in detail, GD has been alternatively called "non-invasive intramucosal carcinoma" or "intraepithelial neoplasia" (IEN) [41,42]. Consequently, to solve this formal linguistic distinction, after the Padova and Vienna international consensus, the World Health Organization (WHO) classification has been proposed ( EA is a malignant epithelial carcinoma with glandular differentiation, which develops in the background of Barrett's esophagus (BE) [43]. It is fundamentally identified as columnar metaplasia which substitutes the stratified squamous epithelium of the distal esophagus [43].…”

“…Consequently, to solve this formal linguistic distinction, after the Padova and Vienna international consensus, the World Health Organization (WHO) classification has been proposed ( EA is a malignant epithelial carcinoma with glandular differentiation, which develops in the background of Barrett's esophagus (BE) [43]. It is fundamentally identified as columnar metaplasia which substitutes the stratified squamous epithelium of the distal esophagus [43]. Pathologists play an important role in surveillance of BE patients to identify precursor/dysplastic lesions by morphological assessment as well as discovering patients at high risk [44,45].…”

Histopathology of Barrett’s Esophagus and Early-Stage Esophageal Adenocarcinoma: An Updated Review

“…It is established that the most important precursor lesion for EAC is Barrett's esophagus (BE) [3]. BE is the result of a metaplastic process where the squamous mucosa in the distal esophagus is replaced by intestinal type mucosa [4,5]. Gastroesophageal reflux is the pivotal risk factor for BE and EAC [6].…”