Gut Liver.  2014 Jul;8(4):356-370.

Barrett's Esophagus and Cancer Risk: How Research Advances Can Impact Clinical Practice

• di Pietro
• Alzoubaidi D
• Fitzgerald RC

Abstract

Barrett's esophagus (BE) is the only known precursor to esophageal adenocarcinoma (EAC), whose incidence has increased sharply in the last 4 decades. The annual conversion rate of BE to cancer is significant, but small. The identification of patients at a higher risk of cancer therefore poses a clinical conundrum. Currently, endoscopic surveillance is recommended in BE patients, with the aim of diagnosing either dysplasia or cancer at early stages, both of which are curable with minimally invasive endoscopic techniques. There is a large variation in clinical practice for endoscopic surveillance, and dysplasia as a marker of increased risk is affected by sampling error and high interobserver variability. Screening programs have not yet been formally accepted, mainly due to the economic burden that would be generated by upper gastrointestinal endoscopy. Screening programs have not yet been formally accepted, mainly due to the economic burden that would be generated by widespread indication to upper gastrointestinal endoscopy. In fact, it is currently difficult to formulate an accurate algorithm to confidently target the population at risk, based on the known clinical risk factors for BE and EAC. This review will focus on the clinical and molecular factors that are involved in the development of BE and its conversion to cancer and on how increased knowledge in these areas can improve the clinical management of the disease.

Keyword

Barrett esophagus; Dysplasia; Cancer; Screening

MeSH Terms

Adenocarcinoma/*etiology
Animals
Barrett Esophagus/*complications/diagnosis
Diagnostic Imaging/methods
Disease Models, Animal
Epigenesis, Genetic/physiology
Esophageal Neoplasms/diagnosis/*etiology
Esophagoscopy/methods
Forecasting
Genetic Markers/physiology
Humans
Mice
Practice Guidelines as Topic
Risk Factors
Genetic Markers