John A Bonino1, Prateek Sharma. 1. Division of Gastroenterology and Hepatology University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, Missouri 64128-2295, USA. psharma@kumc.edu
Abstract
PURPOSE OF REVIEW: Significant advances have been made over the past year to identify individuals with Barrett's esophagus, who are at increased risk of malignant transformation. We summarize some of the important advances in that regard including: improved understanding in areas of epidemiology of those with Barrett's esophagus, identification of the pathways responsible for dysplastic and metaplastic development, selection of patient populations who would most benefit from surveillance protocols, and identification of biomarkers signifying progression of metaplastic changes. RECENT FINDINGS: Barrett's esophagus is being better recognized in patients presenting with extra-esophageal symptoms of gastroesophageal reflux such as chronic cough and asthma. Recent reports from some surgical series further suggest the importance of gastric and even duodenal reflux in the etiology of esophageal metaplastic development. In vitro experiments using acidic environments, to stimulate MAPK pathways, suggest an etiology for increased COX-2 expression. There appears to be a select group of individuals with familial predilection for the development of Barrett's esophagus. Retrospective studies continue to show apparent survival benefit in individuals with Barrett's esophagus undergoing surveillance endoscopy. Endoscopic ablative therapy may provide clinicians an attractive alternative to surgical resection in individuals with high-grade esophageal dysplasia and early adenocarcinoma. SUMMARY: The past year has brought many advances in the epidemiology, pathogenesis, surveillance, and treatment of those with Barrett's esophagus. Clinicians will benefit from review of these advances, and use of the most up-to-date data to ensure better patient outcomes.
PURPOSE OF REVIEW: Significant advances have been made over the past year to identify individuals with Barrett's esophagus, who are at increased risk of malignant transformation. We summarize some of the important advances in that regard including: improved understanding in areas of epidemiology of those with Barrett's esophagus, identification of the pathways responsible for dysplastic and metaplastic development, selection of patient populations who would most benefit from surveillance protocols, and identification of biomarkers signifying progression of metaplastic changes. RECENT FINDINGS: Barrett's esophagus is being better recognized in patients presenting with extra-esophageal symptoms of gastroesophageal reflux such as chronic cough and asthma. Recent reports from some surgical series further suggest the importance of gastric and even duodenal reflux in the etiology of esophageal metaplastic development. In vitro experiments using acidic environments, to stimulate MAPK pathways, suggest an etiology for increased COX-2 expression. There appears to be a select group of individuals with familial predilection for the development of Barrett's esophagus. Retrospective studies continue to show apparent survival benefit in individuals with Barrett's esophagus undergoing surveillance endoscopy. Endoscopic ablative therapy may provide clinicians an attractive alternative to surgical resection in individuals with high-grade esophageal dysplasia and early adenocarcinoma. SUMMARY: The past year has brought many advances in the epidemiology, pathogenesis, surveillance, and treatment of those with Barrett's esophagus. Clinicians will benefit from review of these advances, and use of the most up-to-date data to ensure better patient outcomes.
Authors: Emily G Barr Fritcher; Shannon M Brankley; Benjamin R Kipp; Jesse S Voss; Michael B Campion; Larry E Morrison; Mona S Legator; Lori S Lutzke; Kenneth K Wang; Thomas J Sebo; Kevin C Halling Journal: Hum Pathol Date: 2008-07-07 Impact factor: 3.466