Carcinogenesis of Barrett’s esophagus: a review of the clinical literature

Abstract

Barrett's esophagus (BE) is a premalignant condition of esophageal adenocarcinoma (EAC). Although the incidence of BE has risen rapidly in the West, it is rare in Asia despite a recent increase in the prevalence of gastroesophageal reflux disease. Controversies over the definition of BE are presented because most cases show shortsegment BE, especially ultra-short BE, in Asia. Here we review possible risk factors for the development of EAC, particularly possible roles of ethnicity, specialized intestinal metaplasia (SIM), BE length, and environmental factors, such as Helicobacter pylori infection and obesity. Additionally, we summarize recent studies on the effect of chemoprevention including proton pump inhibitors, nonsteroidal anti-inflammatory drugs or aspirin in order to reduce the risk of neoplastic progression in BE patients. Although substantial knowledge of risk factors of dysplasia/EAC in BE is shown, the risk for neoplastic development may be influenced by geographic variation, study population, the presence or absence of SIM or dysplasia at baseline, and the small number of BE patients investigated. Recently, the efficiency of surveillance for BE patients has been discussed from the standpoint of cost-effectiveness. It may be too difficult to draw conclusions because no randomized clinical trials of BE surveillance have been performed.

Microbial carcinogenesis: Lactic acid bacteria in gastric cancer

“…H. pylori, a Gram-negative curved rod has been associated with 89% of new GAC cases around the world [56,57]. H. pylori chronic infection plays an important role in the early stages of the disease including chronic gastritis, atrophic gastritis and intestinal metaplasia [58][59][60][61][62], however, its colonization in atrophy and intestinal metaplasia is scarce [63,64], leading to the hypothesis that other bacteria within the gastric microbiome are also involved in GAC development. Importantly, the latest clinical guidelines on the management of gastric epithelial precancerous conditions reiterated the need to identify patients with advanced stages of gastritis (i.e.…”

Influence of inhomogeneous static magnetic field-exposure on patients with erosive gastritis: a randomized, self- and placebo-controlled, double-blind, single centre, pilot study

“…The most common cause of erosive gastritis, acute or chronic, is chemical damage: prolonged use of non-steroidal anti-inflammatory drugs (NSAID) such as aspirin and ibuprofen, steroids, oral iron supplement, potassium chloride, fluoride, anticonvulsant drugs, chemotherapeutics, taxol and its derivatives, mycophenolat-, kayekxalat-, kolchicin-or bisphosphonate [3][4][5]. Other agents that can cause erosive gastritis include Helicobacter (H.) pylori infection, biliary reflux, alcohol, cocaine or ionizing radiation [6,7]. Traumatic injuries, critical illness, severe burns, major surgery or hypothermia can also end up in an acute erosive gastritis called stress gastritis [8].…”

“…subgroups were defined for each group: (i) man or woman, (ii) age below 55.6 years or over 55.6 years. Immature cessation of trial: two persons in Group 2, both under the age of 55 6. …”