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Mayo Clinic Proceedings Sep 2019Barrett esophagus is a metaplastic change in the lining of the distal esophageal epithelium, characterized by replacement of the normal squamous epithelium by... (Review)
Review
Barrett esophagus is a metaplastic change in the lining of the distal esophageal epithelium, characterized by replacement of the normal squamous epithelium by specialized intestinal metaplasia. The presence of Barrett esophagus increases the risk of esophageal adenocarcinoma several-fold. Esophageal adenocarcinoma is a malignancy with rapidly rising incidence and persistently poor outcomes when diagnosed after the onset of symptoms. Risk factors for Barrett esophagus include chronic gastroesophageal reflux, central obesity, white race, male gender, older age, smoking, and a family history of Barrett esophagus or esophageal adenocarcinoma. Screening for Barrett esophagus in those with several risk factors followed by endoscopic surveillance to detect dysplasia or adenocarcinoma is currently recommended by society guidelines. Minimally invasive nonendoscopic tools for the early detection of Barrett esophagus are currently being developed. Multimodality endoscopic therapy-using a combination of endoscopic resection and ablation techniques-for the treatment of dysplasia and early adenocarcinoma is successful in eliminating intestinal metaplasia and preventing progression to adenocarcinoma, with outcomes comparable to those after esophagectomy. Risk stratification of those diagnosed with Barrett esophagus is a challenge at present, with active research focused on identifying clinical and biomarker panels to identify those with low and high risk of progression. This narrative review highlights some of the challenges and recent progress in this field.
Topics: Aged; Barrett Esophagus; Biopsy, Needle; Cell Transformation, Neoplastic; Early Detection of Cancer; Endoscopy; Esophagoscopy; Female; Humans; Immunohistochemistry; Incidence; Male; Middle Aged; Precancerous Conditions; Prognosis; Risk Assessment; Treatment Outcome
PubMed: 31486383
DOI: 10.1016/j.mayocp.2019.01.032 -
The New England Journal of Medicine Aug 2014
Review
Topics: Barrett Esophagus; Catheter Ablation; Esophagoscopy; Gastroesophageal Reflux; Humans; Proton Pump Inhibitors
PubMed: 25162890
DOI: 10.1056/NEJMra1314704 -
Gastrointestinal Endoscopy May 2017
Review
Topics: Barrett Esophagus; Early Diagnosis; Endoscopy, Gastrointestinal; Humans; Watchful Waiting
PubMed: 28109913
DOI: 10.1016/j.gie.2017.01.007 -
The Surgical Clinics of North America Jun 2015Although there are many unanswered questions with Barrett esophagus, we can safely say that the incidence is increasing, chemoprevention strategies for the prevention of... (Review)
Review
Although there are many unanswered questions with Barrett esophagus, we can safely say that the incidence is increasing, chemoprevention strategies for the prevention of Barrett metaplasia and its progression to adenocarcinoma may be in the offing, surveillance should be considered for all patients who are discovered to have Barrett esophagus, RFA is the treatment of choice for those with HGD and strongly considered in those with LGD, EMR should be the treatment of choice for patients with nodular high-grade Barrett esophagus, and, finally, vagal-sparing esophagectomy reserved for patients with persistent HGD or a strong suspicion of carcinoma, with consideration of a concomitant fundoplication.
Topics: Adenocarcinoma; Barrett Esophagus; Catheter Ablation; Causality; Comorbidity; Disease Progression; Esophageal Neoplasms; Esophagoscopy; Fundoplication; Gastroesophageal Reflux; Humans; Incidence; Obesity; Odds Ratio; Photochemotherapy; Prevalence; Proton Pump Inhibitors; Risk Factors; Sex Factors; Smoking
PubMed: 25965132
DOI: 10.1016/j.suc.2015.02.011 -
Gastroenterology Clinics of North... Dec 2008Barrett's esophagus is an important step in the pathway to esophageal adenocarcinoma. Since most patients with Barrett's esophagus are undiagnosed and patients present... (Review)
Review
Barrett's esophagus is an important step in the pathway to esophageal adenocarcinoma. Since most patients with Barrett's esophagus are undiagnosed and patients present with advanced adenocarcinoma de novo, prognosis for this disease remains poor. To identify those people with Barrett's esophagus who are at particular risk many new technologies are being developed. In association with these advances in risk stratification, progress is being made in the endoscopic treatment of Barrett's. Chemoprevention is also an area of interest and trials are underway.
Topics: Barrett Esophagus; Humans
PubMed: 19028325
DOI: 10.1016/j.gtc.2008.09.003 -
Seminars in Gastrointestinal Disease Apr 1996When the distal esophagus is lined by a segment of columnar epithelium that is abnormal either because it is extensive or because it has intestinal features, the... (Review)
Review
When the distal esophagus is lined by a segment of columnar epithelium that is abnormal either because it is extensive or because it has intestinal features, the condition is called Barrett's esophagus. Traditionally, Barrett's esophagus has been associated with severe gastroesophageal reflux disease (GERD) and with a high risk for adenocarcinoma. Recently, investigators have shown that short segments of intestinal metaplasia can be found frequently in the distal esophagus of patients who have few signs and symptoms of GERD. For these patients, the risk for carcinogenesis is not clear. This article summarizes the diagnostic and clinical features of Barrett's esophagus and presents an approach to the management of patients with this fascinating disorder.
Topics: Adenocarcinoma; Barrett Esophagus; Deglutition Disorders; Esophageal Neoplasms; Gastroesophageal Reflux; Humans
PubMed: 8705259
DOI: No ID Found -
Gastroenterology May 2002Barrett's esophagus is an acquired condition resulting from severe esophageal mucosal injury. It still remains unclear why some patients with gastroesophageal reflux... (Review)
Review
Barrett's esophagus is an acquired condition resulting from severe esophageal mucosal injury. It still remains unclear why some patients with gastroesophageal reflux disease develop Barrett's esophagus whereas others do not. The diagnosis of Barrett's esophagus is established if the squamocolumnar junction is displaced proximal to the gastroesophageal junction and if intestinal metaplasia is detected by biopsy. Despite this seemingly simple definition, diagnostic inconsistencies remain a problem, especially in distinguishing short segment Barrett's esophagus from intestinal metaplasia of the gastric cardia. Barrett's esophagus would be of little importance were it not for its well-recognized association with adenocarcinoma of the esophagus. The incidence of esophageal adenocarcinoma continues to increase and the 5-year survival rate for this cancer remains dismal. However, cancer risk for a given patient with Barrett's esophagus is lower than previously estimated. Current strategies for improved survival in patients with esophageal adenocarcinoma focus on cancer detection at an early and potentially curable stage. This can be accomplished either by screening more patients for Barrett's esophagus or with endoscopic surveillance of patients with known Barrett's esophagus. Current screening and surveillance strategies are inherently expensive and inefficient. New techniques to improve the efficiency of cancer surveillance are evolving rapidly and hold the promise to change clinical practice in the future. Treatment options include aggressive acid suppression, antireflux surgery, chemoprevention, and ablation therapy, but there is still no clear consensus on the optimal treatment for these patients.
Topics: Adenocarcinoma; Barrett Esophagus; Esophageal Neoplasms; Humans; Incidence; Mass Screening; Population Surveillance; Prevalence
PubMed: 12016424
DOI: 10.1053/gast.2002.33427 -
Seminars in Oncology Aug 1994
Review
Topics: Adenocarcinoma; Barrett Esophagus; Esophageal Neoplasms; Esophagoscopy; Gastroesophageal Reflux; Humans; Laser Therapy; Precancerous Conditions; Ultrasonography
PubMed: 8042041
DOI: No ID Found -
Digestive Diseases and Sciences Aug 2000Barrett's esophagus occurs more frequently than previously anticipated. Detection of Barrett's esophagus is by endoscopic biopsy in which normal squamous epithelium of... (Review)
Review
Barrett's esophagus occurs more frequently than previously anticipated. Detection of Barrett's esophagus is by endoscopic biopsy in which normal squamous epithelium of the esophagus is replaced by a specialized columnar epithelium of any length. Patients with more than five years of gastroesophageal reflux symptoms, particularly those 50 years of age or older, should have upper endoscopy to detect Barrett's esophagus. With recognition of Barrett's esophagus as a premalignant lesion, the crucial issue is surveillance for detection of dysplasia. Although the natural history of dysplasia is incompletely defined, it is clear that patients with dysplasia have a higher risk for adenocarcinoma than those without dysplasia. Dysplasia is not the ideal marker for selecting patients at high risk for adenocarcinoma, however; recent studies have shown that p53 protein accumulation appears to be earlier and more specific/sensitive marker of malignant potential in Barrett's esophagus. Management of Barrett's esophagus often involves a multidisciplinary evaluation and its current status is reviewed.
Topics: Barrett Esophagus; Esophagoscopy; Humans; Tumor Suppressor Protein p53
PubMed: 11007123
DOI: 10.1023/a:1005545918399 -
American Family Physician May 2004Gastroesophageal reflux disease (GERD) is a condition commonly managed in the primary care setting. Patients with GERD may develop reflux esophagitis as the esophagus... (Review)
Review
Gastroesophageal reflux disease (GERD) is a condition commonly managed in the primary care setting. Patients with GERD may develop reflux esophagitis as the esophagus repeatedly is exposed to acidic gastric contents. Over time, untreated reflux esophagitis may lead to chronic complications such as esophageal stricture or the development of Barrett's esophagus. Barrett's esophagus is a premalignant metaplastic process that typically involves the distal esophagus. Its presence is suspected by endoscopic evaluation of the esophagus, but the diagnosis is confirmed by histologic analysis of endoscopically biopsied tissue. Risk factors for Barrett's esophagus include GERD, white or Hispanic race, male sex, advancing age, smoking, and obesity. Although Barrett's esophagus rarely progresses to adenocarcinoma, optimal management is a matter of debate. Current treatment guidelines include relieving GERD symptoms with medical or surgical measures (similar to the treatment of GERD that is not associated with Barrett's esophagus) and surveillance endoscopy. Guidelines for surveillance endoscopy have been published; however, no studies have verified that any specific treatment or management strategy has decreased the rate of mortality from adenocarcinoma.
Topics: Adenocarcinoma; Barrett Esophagus; Esophageal Neoplasms; Esophagoscopy; Gastroesophageal Reflux; Humans; Practice Guidelines as Topic; Risk Factors
PubMed: 15152957
DOI: No ID Found