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World Journal of Gastroenterology Aug 2010Gastroesophageal reflux disease (GERD) affects an estimated 20% of the population in the United States. About 10%-15% of patients with GERD develop Barrett's esophagus,... (Review)
Review
Gastroesophageal reflux disease (GERD) affects an estimated 20% of the population in the United States. About 10%-15% of patients with GERD develop Barrett's esophagus, which can progress to adenocarcinoma, currently the most prevalent type of esophageal cancer. The esophagus is normally lined by squamous mucosa, therefore, it is clear that for adenocarcinoma to develop, there must be a sequence of events that result in transformation of the normal squamous mucosa into columnar epithelium. This sequence begins with gastroesophageal reflux, and with continued injury metaplastic columnar epithelium develops. This article reviews the pathophysiology of Barrett's esophagus and implications for its treatment. The effect of medical and surgical therapy of Barrett's esophagus is compared.
Topics: Barrett Esophagus; Digestive System Surgical Procedures; Disease Progression; Esophageal Neoplasms; Esophagus; Fundoplication; Gastroesophageal Reflux; Gastrointestinal Agents; Humans; Laparoscopy; Metaplasia; Precancerous Conditions; Risk Reduction Behavior; Treatment Outcome
PubMed: 20698038
DOI: 10.3748/wjg.v16.i30.3762 -
Lakartidningen Sep 2023Gastroesophageal reflux disease (GERD) is characterized by regurgitation of gastric juices into the esophagus. This has an erosive effect on the mucosa with accompanying... (Review)
Review
Gastroesophageal reflux disease (GERD) is characterized by regurgitation of gastric juices into the esophagus. This has an erosive effect on the mucosa with accompanying symptoms, such as heartburn, acid regurgitation and positional-/exertion--induced chest pain. The associated inflammation in the multi-layered squamous epithelium of the esophagus (esophagitis) can usually be seen macroscopically at gastroscopy and is always possible to demonstrate microscopically as well-characterized changes. GERD is abundant in the adult population in the Western world, and the incidence appears to be increasing. Serious manifestations of GERD include the appearance of esophageal injury (esophagitis) and columnar lined esophagus (Barrett's esophagus) and, in rare cases, peptic stricture. The glandular-transformed (metaplastic) mucosa carries its clinical significance by constituting the basis for continued cell transformation (development of dysplasia), which eventually might lead to esophageal adenocarcinoma (EAC). EAC is an aggressive form of cancer whose incidence continues to increase in particular in the Western part of the world. In this article the potential mechanisms for the development of the metaplastic glandular epithelium and its progression to dysplasia and cancer is reviewed. In addition, recommendations are given on how important signals about future risks can be captured and managed and how these risks can be minimized and preferably prevented.
Topics: Adult; Humans; Barrett Esophagus; Esophageal Neoplasms; Esophagitis; Gastroesophageal Reflux; Chest Pain
PubMed: 37746770
DOI: No ID Found -
Revista de Gastroenterologia de Mexico Aug 2012
Topics: Barrett Esophagus; Humans
PubMed: 22939466
DOI: 10.1016/j.rgmx.2012.07.005 -
World Journal of Gastroenterology Mar 2022Barrett's esophagus (BE) is a well-established risk factor for esophageal adenocarcinoma. It is recommended that patients have regular endoscopic surveillance, with the... (Review)
Review
Barrett's esophagus (BE) is a well-established risk factor for esophageal adenocarcinoma. It is recommended that patients have regular endoscopic surveillance, with the ultimate goal of detecting early-stage neoplastic lesions before they can progress to invasive carcinoma. Detection of both dysplasia or early adenocarcinoma permits curative endoscopic treatments, and with this aim, thorough endoscopic assessment is crucial and improves outcomes. The burden of missed neoplasia in BE is still far from being negligible, likely due to inappropriate endoscopic surveillance. Over the last two decades, advanced imaging techniques, moving from traditional dye-spray chromoendoscopy to more practical virtual chromoendoscopy technologies, have been introduced with the aim to enhance neoplasia detection in BE. As witnessed in other fields, artificial intelligence (AI) has revolutionized the field of diagnostic endoscopy and is set to cover a pivotal role in BE as well. The aim of this commentary is to comprehensively summarize present evidence, recent research advances, and future perspectives regarding advanced imaging technology and AI in BE; the combination of computer-aided diagnosis to a widespread adoption of advanced imaging technologies is eagerly awaited. It will also provide a useful step-by-step approach for performing high-quality endoscopy in BE, in order to increase the diagnostic yield of endoscopy in clinical practice.
Topics: Adenocarcinoma; Artificial Intelligence; Barrett Esophagus; Endoscopy; Esophageal Neoplasms; Esophagoscopy; Humans
PubMed: 35431503
DOI: 10.3748/wjg.v28.i11.1113 -
Arquivos de Gastroenterologia 2020Barrett's esophagus (BE) is a premalignant condition that raises controversy among general practitioners and specialists, especially regarding its diagnosis, treatment,...
BACKGROUND
Barrett's esophagus (BE) is a premalignant condition that raises controversy among general practitioners and specialists, especially regarding its diagnosis, treatment, and follow-up protocols.
OBJECTIVE
This systematic review aims to present the particularities and to clarify controversies related to the diagnosis, treatment and surveillance of BE.
METHODS
A systematic review was conducted on PubMed, Cochrane, and SciELO based on articles published in the last 10 years. PRISMA guidelines were followed and the search was made using MeSH and non-MeSH terms "Barrett" and "diagnosis or treatment or therapy or surveillance". We searched for complete randomized controlled clinical trials or Phase IV studies, carried out with individuals over 18 years old.
RESULTS
A total of 42 randomized controlled trials were selected after applying all inclusion and exclusion criteria. A growing trend of alternative and safer techniques to traditional upper gastrointestinal endoscopy were identified, which could improve the detection of BE and patient acceptance. The use of chromoendoscopy-guided biopsy protocols significantly reduced the number of biopsies required to maintain similar BE detection rates. Furthermore, the value of BE chemoprophylaxis with esomeprazole and acetylsalicylic acid was relevant, as well as the establishment of protocols for the follow-up and endoscopic surveillance of patients with BE based predominantly on the presence and degree of dysplasia, as well as on the length of the follow-up affected by BE.
CONCLUSION
Although further studies regarding the diagnosis, treatment and follow-up of BE are warranted, in light of the best evidence presented in the last decade, there is a trend towards electronic chromoendoscopy-guided biopsies for the diagnosis of BE, while treatment should encompass endoscopic techniques such as radiofrequency ablation. Risks of ablative endoscopic methods should be weighted against those of resective surgery. It is also important to consider lifetime endoscopic follow-up for both short and long term BE patients, with consideration to limitations imposed by a range of comorbidities. Unfortunately, there are no randomized controlled trials that have evaluated which is the best recommendation for BE follow-up and endoscopic surveillance (>1 cm) protocols, however, based on current International Guidelines, it is recommended esophagogastroduodenoscopy (EGD) every 5 years in BE without dysplasia with 1 up to 3 cm of extension; every 3 years in BE without dysplasia with >3 up to 10 cm of extension, every 6 to 12 months in BE with low grade dysplasia and, finally, EGD every 3 months after ablative endoscopic therapy in cases of BE with high grade dysplasia.
Topics: Barrett Esophagus; Endoscopy, Digestive System; Esophagoscopy; Follow-Up Studies; Humans
PubMed: 33027480
DOI: 10.1590/S0004-2803.202000000-53 -
World Journal of Gastroenterology Dec 2010Barrett's esophagus is a well-known premalignant lesion of the lower esophagus that is characterized by intestinal metaplasia of the squamous epithelium. It is... (Review)
Review
Barrett's esophagus is a well-known premalignant lesion of the lower esophagus that is characterized by intestinal metaplasia of the squamous epithelium. It is clinically important due to the increased risk (0.5% per annum) of progression to esophageal adenocarcinoma (EA), which has a poor outcome unless diagnosed early. The current clinical management of Barrett's esophagus is hampered by the lack of accurate predictors of progression. In addition, when patients develop EA, the current staging modalities are limited in stratifying patients into different prognostic groups in order to guide the optimal therapy for an individual patient. Biomarkers have the potential to improve radically the clinical management of patients with Barrett's esophagus and EA but have not yet entered mainstream clinical practice. This is in contrast to other cancers like breast and prostate for which biomarkers are utilized routinely to inform clinical decisions. This review aims to highlight the most promising predictive and prognostic biomarkers in Barrett's esophagus and EA and to discuss what is required to move the field forward towards clinical application.
Topics: Adenocarcinoma; Barrett Esophagus; Biomarkers, Tumor; Cell Cycle Proteins; Cell Proliferation; Disease Progression; Early Detection of Cancer; Epigenesis, Genetic; Esophageal Neoplasms; Genetic Markers; Humans; Loss of Heterozygosity; Ploidies; Predictive Value of Tests; Prognosis
PubMed: 21128316
DOI: 10.3748/wjg.v16.i45.5669 -
Virchows Archiv : An International... Jan 2018Barrett's oesophagus surveillance biopsies represent a significant share of the daily workload for a busy histopathology department. Given the emphasis on endoscopic... (Review)
Review
Barrett's oesophagus surveillance biopsies represent a significant share of the daily workload for a busy histopathology department. Given the emphasis on endoscopic detection and dysplasia grading, it is easy to forget that the benefits of these screening programs remain unproven. The majority of patients are at low risk of progression to oesophageal adenocarcinoma, and periodic surveillance of these patients is burdensome and costly. Here, we investigate the parallels in the development of Barrett's oesophagus and other scenarios of wound healing in the intestine. There is now increased recognition of the full range of glandular phenotypes that can be found in patients' surveillance biopsies, and emerging evidence suggests parallel pathways to oesophageal adenocarcinoma. Greater understanding of the conditions that favour progression to cancer in the distal oesophagus will allow us to focus resources on patients at increased risk.
Topics: Adenocarcinoma; Barrett Esophagus; Disease Progression; Early Detection of Cancer; Esophageal Neoplasms; Humans; Risk Factors
PubMed: 29500519
DOI: 10.1007/s00428-018-2317-1 -
World Journal of Gastroenterology Jun 2015The burden of illness from esophageal adenocarcinoma continues to rise in the Western world, and overall prognosis is poor. Given that Barrett's esophagus (BE), a... (Review)
Review
The burden of illness from esophageal adenocarcinoma continues to rise in the Western world, and overall prognosis is poor. Given that Barrett's esophagus (BE), a metaplastic change in the esophageal lining is a known cancer precursor, an opportunity to decrease disease development by screening and surveillance might exist. This review examines recent updates in the pathogenesis of BE and comprehensively discusses known risk factors. Diagnostic definitions and challenges are outlined, coupled with an in-depth review of management. Current challenges and potential solutions related to screening and surveillance are discussed. The effectiveness of currently available endoscopic treatment techniques, particularly with regards to recurrence following successful endotherapy and potential chemopreventative agents are also highlighted. The field of BE is rapidly evolving and improved understanding of pathophysiology, combined with emerging methods for screening and surveillance offer hope for future disease burden reduction.
Topics: Adenocarcinoma; Anticarcinogenic Agents; Barrett Esophagus; Biopsy; Disease Progression; Esophageal Neoplasms; Esophagectomy; Esophagoscopy; Humans; Precancerous Conditions; Predictive Value of Tests; Recurrence; Risk Factors; Treatment Outcome
PubMed: 26074687
DOI: 10.3748/wjg.v21.i21.6479 -
Genes & Development Jan 2022Barrett's esophagus (BE) and gastric intestinal metaplasia are related premalignant conditions in which areas of human stomach epithelium express mixed gastric and...
Barrett's esophagus (BE) and gastric intestinal metaplasia are related premalignant conditions in which areas of human stomach epithelium express mixed gastric and intestinal features. Intestinal transcription factors (TFs) are expressed in both conditions, with unclear causal roles and -regulatory mechanisms. Ectopic CDX2 reprogrammed isogenic mouse stomach organoid lines to a hybrid stomach-intestinal state transcriptionally similar to clinical metaplasia; squamous esophageal organoids resisted this CDX2-mediated effect. Reprogramming was associated with induced activity at thousands of previously inaccessible intestine-restricted enhancers, where CDX2 occupied DNA directly. HNF4A, a TF recently implicated in BE pathogenesis, induced weaker intestinalization by binding a novel shadow enhancer and hence activating expression. CRISPR/Cas9-mediated germline deletion of that -element demonstrated its requirement in induction and in the resulting activation of intestinal genes in stomach cells. dCas9-conjugated KRAB repression mapped this activity to the shadow enhancer's HNF4A binding site. Altogether, we show extensive but selective recruitment of intestinal enhancers by CDX2 in gastric cells and that HNF4A-mediated ectopic CDX2 expression in the stomach occurs through a conserved shadow -element. These findings identify mechanisms for TF-driven intestinal metaplasia and a likely pathogenic TF hierarchy.
Topics: Animals; Barrett Esophagus; CDX2 Transcription Factor; Homeodomain Proteins; Metaplasia; Mice; Transcription Factors
PubMed: 34969824
DOI: 10.1101/gad.348983.121 -
Discovery Medicine Nov 2011Barrett's esophagus is a columnar metaplasia conferring an increased risk of adenocarcinoma development. Evidence suggests that this increased risk is due to field... (Review)
Review
Barrett's esophagus is a columnar metaplasia conferring an increased risk of adenocarcinoma development. Evidence suggests that this increased risk is due to field cancerization - the formation of histologically undistinguishable field of clonally derived, mutant cells within the Barrett's segment. Field cancerization can occur prior to both dysplasia and invasive neoplasia and potentially provides a mechanism for the development of multifocal and metachronous tumors. In the gastrointestinal tract, mutant clones spread predominately by crypt fission; the same is likely to be true in Barrett's lesions. Epithelial interactions in the form of cooperation or competition between epithelial clones, as well as with stromal cells, may further drive clone growth. Field cancerization is a clinically relevant phenomenon, knowledge of which could influence the size of resection margins to enhance prognosis after curative surgery, as well as provide a rationale for the development of effective biomarkers for neoplasia risk in Barrett's esophagus. This may provide a foundation for streamlined surveillance programs to prevent the development of invasive tumors.
Topics: Barrett Esophagus; Humans; Prognosis
PubMed: 22127108
DOI: No ID Found