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Gastrointestinal Endoscopy Clinics of... Oct 1994Barrett's esophagus is a complication of gastroesophageal reflux disease that is diagnosed with increasing frequency in connection with the increased utilization of... (Review)
Review
Barrett's esophagus is a complication of gastroesophageal reflux disease that is diagnosed with increasing frequency in connection with the increased utilization of upper endoscopy. It remains unclear why some patients with gastroesophageal reflux disease develop Barrett's esophagus while others do not. The association of Barrett's esophagus and adenocarcinoma is well established; if not for this fact, Barrett's esophagus would be of little clinical importance. Endoscopic surveillance with a rigorous biopsy protocol for the detection of dysplasia or early adenocarcinoma is indicated in any patient with Barrett's esophagus who is a candidate for surgery. New therapeutic strategies, including profound acid suppression with proton pump inhibitors, laser ablation of Barrett's epithelium, and photodynamic therapy, are currently under evaluation for the treatment of Barrett's esophagus.
Topics: Adenocarcinoma; Barrett Esophagus; Biopsy; Combined Modality Therapy; Esophageal Neoplasms; Esophagectomy; Esophagoscopy; Esophagus; Humans; Laser Therapy; Photochemotherapy; Precancerous Conditions
PubMed: 7812646
DOI: No ID Found -
Gastrointestinal Endoscopy Clinics of... Jul 2017
Topics: Barrett Esophagus; Humans; Risk Assessment
PubMed: 28577775
DOI: 10.1016/j.giec.2017.04.001 -
Annals of Diagnostic Pathology Dec 2018Biopsy samples from esophageal columnar metaplasia and dysplasia are commonly encountered in Western pathology practice and knowing a few pitfalls can save both... (Review)
Review
Biopsy samples from esophageal columnar metaplasia and dysplasia are commonly encountered in Western pathology practice and knowing a few pitfalls can save both pathologists and patients a great deal of anxiety. Herein we discuss criteria for Barrett esophagus, evaluation of dysplasia, and some pitfalls in reviewing endoscopic mucosal resections. Also included is a summary of suggested follow-up for patients with Barrett esophagus.
Topics: Barrett Esophagus; Endoscopic Mucosal Resection; Humans
PubMed: 30312881
DOI: 10.1016/j.anndiagpath.2018.09.013 -
JAMA Aug 2013Barrett esophagus, a complication of gastroesophageal reflux disease (GERD), predisposes patients to esophageal adenocarcinoma, a tumor that has increased in incidence... (Review)
Review
IMPORTANCE
Barrett esophagus, a complication of gastroesophageal reflux disease (GERD), predisposes patients to esophageal adenocarcinoma, a tumor that has increased in incidence more than 7-fold over the past several decades. Controversy exists regarding the issues of endoscopic screening and surveillance for Barrett esophagus, treatment for the underlying GERD, and the role of endoscopic eradication therapy.
OBJECTIVES
To review current concepts on the pathogenesis, diagnosis, and treatment of Barrett esophagus; to discuss the importance of dysplasia and the role of endoscopic eradication therapy for its treatment; and to review current management guidelines.
EVIDENCE REVIEW
MEDLINE and the Cochrane Library were searched from 1984 to April 2013. Additional citations were obtained by reviewing references from selected research and review articles.
FINDINGS
Risk factors for cancer in Barrett esophagus include chronic GERD, hiatal hernia, advanced age, male sex, white race, cigarette smoking, and obesity with an intra-abdominal body fat distribution. The annual risk of esophageal cancer is approximately 0.25% for patients without dysplasia and 6% for patients with high-grade dysplasia. High-quality studies have found no significant differences in cancer incidence for patients with Barrett esophagus whose GERD is treated medically or surgically. Endoscopic eradication therapy with radiofrequency ablation significantly reduces the frequency of progression to cancer for patients with high-grade dysplasia.
CONCLUSIONS AND RELEVANCE
Endoscopic screening is recommended for patients with multiple risk factors for cancer in Barrett esophagus. For patients with Barrett esophagus without dysplasia, endoscopic surveillance at intervals of 3 to 5 years is recommended, and GERD is treated much as it is for patients without Barrett esophagus. Endoscopic eradication therapy is the treatment of choice for high-grade dysplasia and is an option for low-grade dysplasia. Endoscopic eradication therapy is not recommended for the general population of patients with nondysplastic Barrett esophagus.
Topics: Barrett Esophagus; Early Detection of Cancer; Esophageal Neoplasms; Esophagoscopy; Gastroesophageal Reflux; Humans; Risk Factors
PubMed: 23942681
DOI: 10.1001/jama.2013.226450 -
Expert Review of Molecular Diagnostics Nov 2018Esophageal adenocarcinoma (EAC) has a poor 5-year survival rate (10%-18%), and incidence has increased dramatically in the past three decades. Barrett's esophagus (BE)... (Review)
Review
Esophageal adenocarcinoma (EAC) has a poor 5-year survival rate (10%-18%), and incidence has increased dramatically in the past three decades. Barrett's esophagus (BE) is the precursor lesion to EAC and is the replacement of the normally squamous lined esophagus with columnar cells that develop an intestinal phenotype characterized by the presence of goblet cells. Given the known precursor state, EAC is amenable to screening and surveillance strategies (analogous to colon cancer). However, unlike from colon cancer screening, BE poses challenges that make effective screening difficult. Robust and concerted effort is under way to find biomarkers of BE. Areas covered: This review summarizes current known biomarkers for BE. These include dysplasia, genomic markers, and gene expression alterations that occur early in the dysplasia/carcinoma sequence. Expert commentary: Despite the tremendous breadth of work in studying molecular advances, the ideal biomarker for BE has not yet been discerned. This review comments on innovations in the field of BE research that combine state-of-the-art molecular advances with simple technologies.
Topics: Barrett Esophagus; Biomarkers; Epigenesis, Genetic; Genomic Instability; Humans
PubMed: 30345836
DOI: 10.1080/14737159.2018.1538793 -
Digestive Diseases and Sciences Aug 2018New improved methods are required for the early detection of esophageal adenocarcinoma in order to reduce mortality from this aggressive cancer. In this review we... (Review)
Review
New improved methods are required for the early detection of esophageal adenocarcinoma in order to reduce mortality from this aggressive cancer. In this review we discuss different screening methods which are currently under evaluation ranging from image-based methods to cell collection devices coupled with biomarkers. As Barrett's esophagus is a low prevalence disease, potential screening tests must be applied to an enriched population to reduce the false-positive rate and improve the cost-effectiveness of the program.
Topics: Barrett Esophagus; Biomarkers, Tumor; Early Detection of Cancer; Feasibility Studies; Humans; Polymorphism, Single Nucleotide
PubMed: 29995243
DOI: 10.1007/s10620-018-5192-3 -
Digestive Diseases and Sciences Aug 2018The management of Barrett's esophagus and early esophageal adenocarcinoma has shifted away from esophagectomy and toward endoscopic techniques, including endoscopic... (Review)
Review
The management of Barrett's esophagus and early esophageal adenocarcinoma has shifted away from esophagectomy and toward endoscopic techniques, including endoscopic resection and ablative therapies. The most commonly used ablative therapies are radiofrequency ablation and cryotherapy. Radiofrequency ablation has risen to the top of the management algorithm due to its favorable safety profile and established track record of efficacy in patients with dysplastic Barrett's. Cryotherapy offers early promise as an alternatively safe and effective ablative modality. We review radiofrequency ablation and cryotherapy techniques, and updated data regarding their efficacy and safety as well as their roles in the management of Barrett's esophagus.
Topics: Barrett Esophagus; Catheter Ablation; Comparative Effectiveness Research; Cryosurgery; Cryotherapy; Endoscopic Mucosal Resection; Esophagus; Humans; Mucous Membrane
PubMed: 29777441
DOI: 10.1007/s10620-018-5064-x -
Is Barrett's esophagus an over-hyped disease in the West, and an underdiagnosed disease in the East?Digestive Endoscopy : Official Journal... May 2013Despite the widespread practice of endoscopic surveillance for Barrett's esophagus in the West, this strategy has not been shown to reduce mortality from esophageal... (Review)
Review
Despite the widespread practice of endoscopic surveillance for Barrett's esophagus in the West, this strategy has not been shown to reduce mortality from esophageal adenocarcinoma. Coupled with the very low absolute annual risk of Barrett's adenocarcinoma of 0.1%, this has called into question as to whether Barrett's esophagus is an over-hyped condition in the West. On the contrary, it is widely assumed that the prevalence of Barrett's esophagus is low in Asia. Could there be under-recognition of Barrett's esophagus, resulting in the underdiagnosis of the disease in the region? Our own study noted a much higher prevalence of histologically confirmed Barrett's esophagus following increased interest in endoscopic investigation of this disease, suggesting the low prevalence of Barrett's esophagus reported in most parts of Asia could have been attributed, at least in part, to underdiagnosis and/or lack of awareness of the condition. Training in the use of standardized diagnostic criteria could enhance diagnosis of the disease. In a recent study conducted by the Asia-Pacific Barrett's Consortium, formal training in the endoscopic recognition of columnar-lined Barrett's segment enhanced endoscopists' detection of the disease and led to significantly higher diagnostic yield (1.5% vs 0.42% in untrained endoscopists). The use of advanced endoscopic imaging technology such as narrow-band imaging improved the negative predictive value in the diagnosis of Barrett's esophagus's associated neoplasia. Raman spectroscopy, a novel biomolecular probe-based technology that does not rely upon operator's interpretation of images, could potentially enhance the detection of Barrett's esophagus and associated neoplasia.
Topics: Asia; Barrett Esophagus; Esophagoscopy; Humans; Prevalence
PubMed: 23617669
DOI: 10.1111/den.12105 -
Revista de Gastroenterologia de Mexico 2016Barrett's esophagus is a premalignant condition of the esophagus in which the squamous epithelium of the lower end of the esophagus is replaced with columnar epithelium.... (Review)
Review
Barrett's esophagus is a premalignant condition of the esophagus in which the squamous epithelium of the lower end of the esophagus is replaced with columnar epithelium. Since the incidence of esophageal adenocarcinoma is on the rise, the major gastroenterology societies have come up with their recommendations for screening and surveillance. Specific factors like obesity, white race, age over 50 years, early age of onset of GERD, smoking and hiatal hernia have been identified as increasing the risk of Barrett's esophagus and adenocarcinoma. The diagnosis requires both endoscopic identification of columnar-lined mucosa and histological confirmation with biopsy. Most medical societies recommend screening people with GERD and other risk factors with endoscopy, but other alternatives employing less invasive methods are currently being studied. Surveillance strategies vary depending on the endoscopic findings and the Seattle biopsy protocol with random 4-quadrant sampling is recommended. Biomarkers have shown promising results, but more studies are needed in the future. White light endoscopy is the standard practice, but other advanced imaging modalities have shown variable results and hence more studies are awaited for further validation. Endoscopic eradication techniques, including both resection and ablation, have shown good but variable results for treating dysplastic lesions confined to the mucosa. Resection procedures to remove visible lesions followed by ablation of the dysplastic mucosa have shown the best results with higher eradication rates and lower recurrence rates. Surgical management is reserved for lesions with sub-mucosal invasion and lymph node spread with increased risk of metastasis.
Topics: Barrett Esophagus; Humans; Risk Factors
PubMed: 26964773
DOI: 10.1016/j.rgmx.2015.07.007 -
Chest Surgery Clinics of North America Nov 1994The development of the columnar-lined lower esophagus, or Barrett's disease, is an acquired condition due to reflux of gastric and duodenal contents. The medical... (Review)
Review
The development of the columnar-lined lower esophagus, or Barrett's disease, is an acquired condition due to reflux of gastric and duodenal contents. The medical treatment of patients with reflux disease and Barrett's esophagus is currently the same as for patients with reflux without Barrett's disease which may indicate more aggressive antireflux control. Constant surveillance of the Barrett's mucosa remains important. The progression of squamous epithelium to Barrett's metaplasia and eventually invasive carcinoma in a subgroup of patients is well described and becoming more frequent. The discovery of this carcinogenic process is becoming extremely important as it may help improve the dismal long-term prognosis of patients with adenocarcinoma of the distal esophagus and gastroesophageal junction.
Topics: Barrett Esophagus; Humans
PubMed: 7859006
DOI: No ID Found