American Gastroenterological Association Technical Review on the Management of Barrett's Esophagus

Spechler, Stuart J.; Sharma, Prateek; Souza, Rhonda F.; Inadomi, John M.; Shaheen, Nicholas J.

doi:10.1053/j.gastro.2011.01.031

Cited by 1,019 publications

(720 citation statements)

References 304 publications

(291 reference statements)

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“…In the United Kingdom, the AspECT trial is currently evaluating the combination of high-dose proton pump inhibitors and aspirin in minimizing the risk of progression to cancer in 9000 BE sufferers [44] . A similar prospective study is running in the United States [45] . In the only prospective interventional study published today, Heath et al [46] randomized 100 patients who had either low or high-grade dysplasia and BE to receive either a COX-2 selective NSAID (celecoxib) or placebo.…”

Section: Nsaids and Eac Chemopreventionmentioning

confidence: 99%

Role of chemoprophylaxis with either NSAIDs or statins in patients with Barrett’s esophagus

Tsibouris

Vlachou

Isaacs

2014

WJGPT

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The incidence of esophageal adenocarcinoma, a poor prognosis neoplasia, has risen dramatically in recent decades. Barrett's esophagus represents the best-known risk factor for esophageal adenocarcinoma development. Non-steroidal anti-inflammatory drugs through cyclooxygenase-2 inhibition and prostaglandin metabolism regulation could control cell proliferation, increase cell apoptosis and regulate the expression of growth and angiogenic factors. Statins can achieve equivalent effects through prenylation and subsequently control of cellular signaling cascades. At present, epidemiological studies are small and underpowered. Their data could not justify either medication as a chemo-preventive agent. Population based studies have shown a 43% reduction of the odds of developing an esophageal adenocarcinoma, leaving out or stating a 25% reduction in patients consuming non-aspirin nonsteroidal antiinflammatory drugs and a 50% reduction in those patients consuming aspirin. They have also stated a 19% reduction of esophageal cancer incidence when statins have been used. Observational studies have shown that non-steroidal anti-inflammatory drugs could reduce the adenocarcinoma incidence in patients with Barrett's esophagus by 41%, while statins could reduce the risk by 43%. The cancer preventive effect has been enhanced in those patients taking a combination of non-steroidal anti-inflammatory drugs and statins (a 74% decrease). Observational data are equivocal concerning the efficacy of non-steroidal anti-inflammatory drug subclasses. Non-steroidal anti-inflammatory drugs clearly have substantial potential for toxicity, while statins are rather safe drugs. In conclusion, both non-steroidal anti-inflammatory drugs and statins are promising chemopreventive agents and deserve further exploration with interventional studies. In the meanwhile, their use is justified only in patients with cardiovascular disease.© 2014 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Esophageal adenocarcinoma; Barrett's esophagus; Non-steroidal anti-inflammatory drugs; Aspirin; Statins; Cancer chemoprevention Core tip: Esophageal adenocarcinoma remains a major burden upon health. Experimental studies have suggested that non-steroidal anti-inflammatory drugs and statins may have useful actions against esophageal cancer cells. This review of observational studies shows that non-steroidal anti-inflammatory drugs reduced adenocarcinoma incidence in patients with Barrett' s esophagus by 41%, while statins reduced the risk by 43%. The cancer preventive effect is enhanced in those patients taking a combination of non-steroidal anti-inflammatory drugs and statins (a 74% decrease). Non-steroidal anti-inflammatory drugs clearly have substantial potential for toxicity, while statins are rather safe drugs. Their combination offers promise for chemoprevention and further interventional studies are warranted.Tsibouris P, Vlachou E, Isaacs PET. Role of chemoprophylaxis REVIEWOnline Submissions: http://www.wjgnet.com/esps/

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Section: Nsaids and Eac Chemopreventionmentioning

confidence: 99%

Role of chemoprophylaxis with either NSAIDs or statins in patients with Barrett’s esophagus

Tsibouris

Vlachou

Isaacs

2014

WJGPT

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“…The risk of progression of BE within the different stages is also difficult to accurately predict (2,3,6,7). In general, the risk of progression to EAC is lower in BE patients with IM and increases progressively in BE patients with LGD and HGD (2,3,6).…”

Section: Introductionmentioning

confidence: 99%

“…Endoscopic radiofrequency ablation (RFA) is used for flat HGD (3,7,10-12) and esophagectomy is reserved only for patients with EAC that extends into the submucosa (7,11). Consensus documents also recommend endoscopic ablation for BE patients with LGD (2,3,6,7), while the optimum treatment of IM remains unclear and further research is required (2,3,11,12).…”

Section: Introductionmentioning

confidence: 99%

Economic evaluation of endoscopic radiofrequency ablation for the treatment of dysplastic Barretts esophagus in Spain

et al. 2017

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“…[3][4][5] In the United States, Barrett's esophagus is defined as a change in the distal esophageal epithelium of any length, recognized as columnar-type epithelium on endoscopy, and confirmed to have intestinal metaplasia by biopsy of the tubular esophagus. 6 Controversy exists on whether intestinal metaplasia with goblet cells should be an essential criterion for the diagnosis of Barrett's esophagus, and there are studies demonstrating a close relationship between esophageal adenocarcinoma and cardiac-type mucosa. 7 However, multiple studies have shown that columnar epithelium with goblet cells represents the only type of columnar epithelium at significant risk for adenocarcinoma.…”

mentioning

confidence: 99%

Expression of SOX9 and CDX2 in nongoblet columnar-lined esophagus predicts the detection of Barrett's esophagus during follow-up

2015

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The diagnosis of Barrett's esophagus in the United States requires both endoscopically evident columnar-lined esophagus and the presence of goblet cells by histology. Currently, there is no consensus on how patients with nongoblet columnar-lined esophagus should be followed. In this study, we investigated whether biomarkers can be used to predict the detection of goblet cells in follow-up biopsies. Patients with nongoblet columnar-lined esophagus were identified. In 13 of these cases, goblet cells were detected in subsequent follow-up endoscopic biopsies (Barrett's group). Additionally, 26 cases that remained negative for goblet cells in follow-up biopsies served as controls. Immunohistochemistry for CDX2, SOX9, BMP4, SHH, and MUC2 was performed on the initial biopsies and graded independently by at least two pathologists in a masked manner. CDX2 was positive in the nongoblet columnar epithelium of 7/13 cases in the Barrett's group and in 4/26 controls (sensitivity 54%, specificity of 85%, odds ratio (OR) 6.4). Strong and diffuse immunoreactivity for SOX9 was detected in 10/13 cases in the Barrett's group and in 1/26 controls (sensitivity 77%, specificity 96%, OR 83.3). Combining CDX2 and SOX9 as a panel increased sensitivity to 85%, although the specificity decreased to 85% (OR 30.3). SHH, BMP4, and MUC2 expression showed no significant difference between the Barrett's and control groups. In patients with nongoblet columnar-lined esophagus, SOX9 and CDX2 may be useful in identifying a subset of patients who have a higher risk of being diagnosed for Barrett's esophagus (developing goblet cells) and need closer follow-up.

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American Gastroenterological Association Technical Review on the Management of Barrett's Esophagus

Cited by 1,019 publications

References 304 publications

Role of chemoprophylaxis with either NSAIDs or statins in patients with Barrett’s esophagus

Role of chemoprophylaxis with either NSAIDs or statins in patients with Barrett’s esophagus

Economic evaluation of endoscopic radiofrequency ablation for the treatment of dysplastic Barretts esophagus in Spain

Expression of SOX9 and CDX2 in nongoblet columnar-lined esophagus predicts the detection of Barrett's esophagus during follow-up

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American Gastroenterological Association Technical Review on the Management of Barrett's Esophagus

Cited by 1,019 publications

References 304 publications

Role of chemoprophylaxis with either NSAIDs or statins in patients with Barrett’s esophagus

Role of chemoprophylaxis with either NSAIDs or statins in patients with Barrett’s esophagus

Economic evaluation of endoscopic radiofrequency ablation for the treatment of dysplastic Barretts esophagus in Spain

Expression of SOX9 and CDX2 in nongoblet columnar-lined esophagus predicts the detection of Barrett's esophagus during follow-up

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Economic evaluation of endoscopic radiofrequency ablation for the treatment of dysplastic Barretts esophagus in Spain