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Gastroenterology Clinics of North... Sep 2022While patients with Barrett's esophagus without dysplasia may benefit from endoscopic surveillance, those with low-grade dysplasia may be managed with either endoscopic... (Review)
Review
While patients with Barrett's esophagus without dysplasia may benefit from endoscopic surveillance, those with low-grade dysplasia may be managed with either endoscopic surveillance or endoscopic eradication. Patients with Barrett's esophagus with high-grade dysplasia and/or intramucosal adenocarcinoma will generally require endoscopic eradication therapy. The management of Barrett's esophagus with dysplasia and early esophageal adenocarcinoma is predominantly endoscopic, with multiple effective methods available for the resection of raised neoplasia and ablation of flat neoplasia. High-dose proton-pump inhibitor therapy is advised during the treatment of Barrett's esophagus with dysplasia and early esophageal adenocarcinoma. After the endoscopic eradication of Barrett's esophagus and associated neoplasia, surveillance is required for the diagnosis and retreatment of recurrence or progression.
Topics: Adenocarcinoma; Barrett Esophagus; Esophageal Neoplasms; Esophagoscopy; Humans; Hyperplasia; Proton Pump Inhibitors
PubMed: 36153106
DOI: 10.1016/j.gtc.2022.06.004 -
Digestive Diseases and Sciences Aug 2018Barrett'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... (Review)
Review
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.
Topics: Adenocarcinoma; Age Factors; Barrett Esophagus; Disease Progression; Epidemiological Monitoring; Esophageal Neoplasms; Humans; Incidence; Precancerous Conditions; Risk Factors; Sex Factors
PubMed: 29905908
DOI: 10.1007/s10620-018-5161-x -
Revista Espanola de Enfermedades... Oct 2019Barrett's esophagus (BE) is a controversial condition. The significance of this condition lies in its premalignant potential, so it is important that clinically... (Review)
Review
Barrett's esophagus (BE) is a controversial condition. The significance of this condition lies in its premalignant potential, so it is important that clinically applicable biomarkers be identified for early detection and targeted prevention. Dysplasia is currently used as main biomarker, but others most recently surveyed in cancer also include microRNAs. Classically, BE was considered to be an acquired disease related to pathological gastroesophageal acid and bile reflux. However, some cases are associated with genetic predisposition, representing an inherited, familial form of BE. The actual gene, or genes, involved in this condition have not yet been identified. Main therapeutic options include medical treatment and antireflux surgery. Both types of treatment are equally efficient in controlling symptoms and neither is able to cause the metaplastic segment to disappear, which is why the risk of malignancy remains. However, we may use endoscopic radiofrequency to eradicate BE and replace it by the typical squamous epithelium of the esophagus. The currently accepted indications of radiofrequency in BE include low- and high-grade dysplasia, but not Barrett's esophagus without dysplasia. In conclusion, BE may have two different presentations: environmental ("human", reflux) or sporadic BE, which is the most common form, and genetic ("divine", inherited) or familiar BE, less common but with a greater risk for malignancy. As they might be two different diseases, surveillance programs and treatments should also be different.
Topics: Barrett Esophagus; Esophageal Neoplasms; Fundoplication; Gastroesophageal Reflux; Gene-Environment Interaction; Genetic Markers; Humans; MicroRNAs; Pedigree; Proton Pump Inhibitors; Radiofrequency Ablation
PubMed: 31566411
DOI: 10.17235/reed.2019.6261/2019 -
Romanian Journal of Internal Medicine =... Sep 2020The incidence of Barrett's Esophagus (BE) is increasing worldwide, thus diagnosis is becoming a major key of interest in preventing esophageal adenocarcinoma. Because... (Review)
Review
BACKGROUND AND AIMS
The incidence of Barrett's Esophagus (BE) is increasing worldwide, thus diagnosis is becoming a major key of interest in preventing esophageal adenocarcinoma. Because the status of BE in Romania is unclear, we performed a narrative review to comprehensively evaluate all published articles on BE from Romania.
METHODS
We conducted a systematic literature search of PubMed data base and of all Romanian medical journals. The abstracts and the titles of the identified studies were reviewed to exclude the studies that did not answer the search question. In addition we performed a manual search to identify articles on this topic published earlier in local journals or not indexed on internet.
RESULTS
A total of 17 articles were found. 8 studies and 9 reviews were identified, with a total of 8,829 participants enrolled. The results showed that the median age ranges between 54-59 years, with a predominance for male sex, the main risk factors, such as gastroesophageal reflux disease, obesity, smoking, hiatal hernia, are also present in Romania and infection with H. pylori has a protective effect. The diagnosis of Barrett's esophagus in Romania is established in agreement with international guidelines.
CONCLUSIONS
There are not many publications on BE in Romania. However the data in this country are similar to those reported in other countries. The management is carried out according to standard guidelines. Diagnosing BE relies on endoscopic techniques and classification systems. Risk factors such as gastroesophageal reflux, hiatal hernia, obesity and Helicobacter pylori are considered in Romanian articles. More studies are welcome on this matter in our country.
Topics: Age Factors; Barrett Esophagus; Gastroesophageal Reflux; Helicobacter Infections; Helicobacter pylori; Hernia, Hiatal; Humans; Protective Factors; Risk Factors; Romania; Sex Factors; Smoking
PubMed: 32364520
DOI: 10.2478/rjim-2020-0007 -
Journal of Medicine and Life 2014The injury of the esophageal epithelium may be determined by the reflux of the gastric acid in the esophagus. Barrett's esophagus (BE) is characterized by the... (Review)
Review
The injury of the esophageal epithelium may be determined by the reflux of the gastric acid in the esophagus. Barrett's esophagus (BE) is characterized by the replacement of the normal squamous epithelium with the columnar epithelium, when the healing of the lesion occurs. According to some studies, the incidence of the esophageal adenocarcinoma in patients with BE is of about 0,5% per year. The term Barrett's esophagus is subjected to interpretation nowadays, so it lacks the clarity needed for the clinical and scientific communication on the subject of columnar metaplasia of the esophageal mucosa. The major pathogenetic factor in the development of BE is represented by the reflux disease. The cellular origin of BE is controversial and it represents an issue that needs to be resolved because it will have implications in the putative molecular mechanisms underlying the metaplastic process. The epigenetic or genetic changes, which alter protein expression, function, and/ or activity, in post-mitotic cells to drive transdifferentiation or in stem/ progenitor cells such that they are reprogrammed to differentiate into columnar rather than squamous cells, are driven by the inflammatory environment created by chronic reflux. In order to be able to develop better therapeutic strategies for the patients with this disease, an increasing interest in understanding the pathogenesis of BE at the cellular and molecular level presents these days.
Topics: Barrett Esophagus; Cell Differentiation; History, 20th Century; Humans; Signal Transduction; Transcription Factors
PubMed: 25870690
DOI: No ID Found -
European Review For Medical and... Aug 2022Identificating factors associated with an increased risk for dysplasia and cancer development among patients with Barrett esophagus would aid better patient care and...
OBJECTIVE
Identificating factors associated with an increased risk for dysplasia and cancer development among patients with Barrett esophagus would aid better patient care and improve risk stratification approaches. This study aimed at examining the frequency of Barrett esophagus and factors predicting the presence of dysplasia and cancer among patients with Barrett esophagus.
PATIENTS AND METHODS
Adult patients that underwent upper gastrointestinal endoscopic examination for gastroesophageal complaints were screened in this retrospective, cross-sectional study; and patients diagnosed with Barrett esophagus were included in the analysis. Frequency of dysplasia/cancer and its predictors were examined.
RESULTS
Among 10,404 endoscopic examinations performed during the study period, 143 patients (1.4%) were diagnosed with Barrett esophagus. Among patients with Barrett esophagus, the frequency for high-grade dysplasia, low grade dysplasia, and adenocarcinoma was 2.8%, 2.1%, and 1.4%, respectively. On multivariate analysis, age ≥55 years (OR, 11.1 [95%CI: 2.0-61.4], p=0.006) and long segment Barrett esophagus (OR, 5.7 [95%CI: 1.2-27.8], p=0.031) emerged as significant independent predictors for dysplasia/cancer.
CONCLUSIONS
Frequency of Barrett esophagus in our population seems to be different than figures reported from different geographical regions. Advanced age and long Barrett segment on endoscopic examination are associated with the presence of concomitant dysplasia/cancer on pathological examination. Larger studies with prospective methodology are warranted.
Topics: Adult; Barrett Esophagus; Cross-Sectional Studies; Esophageal Neoplasms; Humans; Hyperplasia; Middle Aged; Prospective Studies; Retrospective Studies
PubMed: 36066163
DOI: 10.26355/eurrev_202208_29527 -
Cleveland Clinic Journal of Medicine Nov 2019Barrett esophagus is found in 5% to 15% of patients with gastroesophageal reflux disease and is a precursor of esophageal adenocarcinoma, yet the condition often goes... (Review)
Review
Barrett esophagus is found in 5% to 15% of patients with gastroesophageal reflux disease and is a precursor of esophageal adenocarcinoma, yet the condition often goes undiagnosed. Patients with reflux disease who are male, over age 50, or white, and who smoke or have central obesity or a family history of Barrett esophagus or esophageal adenocarcinoma, should undergo initial screening endoscopy and, if no dysplasia is noted, surveillance endoscopy every 3 to 5 years. Dysplasia is treated with endoscopic eradication by ablation, resection, or both. Chemoprotective agents are being studied to prevent progression to dysplasia in Barrett esophagus. The authors discuss current recommendations for screening and management.
Topics: Adenocarcinoma; Barrett Esophagus; Combined Modality Therapy; Esophageal Neoplasms; Humans
PubMed: 31710585
DOI: 10.3949/ccjm.86a.18106 -
Gastroenterology Apr 2023Endoscopic surveillance of Barrett's esophagus, aiming to detect prevalent dysplasia and adenocarcinoma, followed by effective endoscopic treatment, is an integral part...
Endoscopic surveillance of Barrett's esophagus, aiming to detect prevalent dysplasia and adenocarcinoma, followed by effective endoscopic treatment, is an integral part of the esophageal adenocarcinoma prevention paradigm. However, several limitations, such as the subtle appearance of dysplasia, sampling error (inherent in current surveillance protocols), and noncompliance with surveillance recommendations, lead to missed dysplasia and neoplasia, reducing the effectiveness of surveillance as currently practiced. Careful endoscopic assessment with high-resolution white-light endoscopy, dye-based or electronic chromoendoscopy, and comprehensive sampling of the BE mucosa, remains the cornerstone of endoscopic surveillance. Emerging innovations in this area span the gamut of more efficient sampling methods, advanced imaging tools, artificial intelligence, and molecular marker-powered approaches as adjuncts, to identify prevalent and predict incident dysplasia or adenocarcinoma. Development and implementation of validated quality indicators will allow additional advancement of this critical field. These approaches will hopefully enable efficient and effective cancer prevention and treatment.
Topics: Humans; Barrett Esophagus; Artificial Intelligence; Esophageal Neoplasms; Adenocarcinoma; Endoscopy; Esophagoscopy
PubMed: 36746210
DOI: 10.1053/j.gastro.2023.01.031 -
The Surgical Clinics of North America Oct 2012Barrett esophagus is characterized by the replacement of squamous mucosa in the esophagus by specialized intestinal metaplasia. Its clinical significance lies in it... (Review)
Review
Barrett esophagus is characterized by the replacement of squamous mucosa in the esophagus by specialized intestinal metaplasia. Its clinical significance lies in it being the strongest risk factor for and known precursor for esophageal adenocarcinoma. Diagnosis requires endoscopic confirmation of columnar metaplasia in the distal esophagus and histologic confirmation of specialized intestinal metaplasia. Recommendations for the management of subjects diagnosed with Barrett esophagus include periodic endoscopic surveillance to detect the development of high-grade dysplasia or adenocarcinoma. Careful endoscopic evaluation with high-resolution endoscopy and endoscopic resection is recommended in the evaluation of subjects with high-grade dysplasia and early adenocarcinoma.
Topics: Ablation Techniques; Barrett Esophagus; Biomarkers; Early Diagnosis; Esophagoscopy; Fundoplication; Humans; Population Surveillance; Proton Pump Inhibitors; Risk Assessment
PubMed: 23026274
DOI: 10.1016/j.suc.2012.07.009 -
Internal Medicine (Tokyo, Japan) Feb 2021Barrett's esophagus (BE) is a precancerous disease that can lead to esophageal adenocarcinoma (EAC). Recently, the incidence of EAC arising from BE has been increasing,...
Barrett's esophagus (BE) is a precancerous disease that can lead to esophageal adenocarcinoma (EAC). Recently, the incidence of EAC arising from BE has been increasing, and EAC has now become a threat in many countries. However, there are many gaps among the various countries in terms of definitions and concepts and these gaps prevent discussing BE on the same footing. In order to eradicate BE, it is a global necessity to fill in these remaining gaps. We focused on the gaps and reviewed recent evidence and trends as well as the background of gaps between the US and Japan as two of the leading countries in the field of medical research. We also review the rapid advances in endoscopic techniques in relation to both diagnosis and therapy that are considered to be useful to eliminate the gaps between countries.
Topics: Adenocarcinoma; Barrett Esophagus; Endoscopy; Esophageal Neoplasms; Humans; Japan
PubMed: 32863360
DOI: 10.2169/internalmedicine.4400-19