Diagnosis and Management of Barrett's Esophagus

Nelsen, Eric M.; Hawes, Robert H.; Iyer, Prasad G.

doi:10.1016/j.suc.2012.07.009

Cited by 18 publications

(10 citation statements)

References 118 publications

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“…Another treatment option for high grade dysplasia is esophageal mucosal resection (EMR) or esophageal mucosal dissection. EMR dissects the esophageal submucosa to better evaluate and stage early carcinoma [66] . It has been suggested the EMR be performed on lesions with a diameter ≤ 2 cm and only occurs in less than one third of the esophageal wall circumference.…”

Section: Treatmentmentioning

confidence: 99%

Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities

Napier

Scheerer

Misra

2014

WJGO

690

604

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of current treatment include surgery, radiation and chemotherapy. Tumor markers of esophageal cancer are an advancing area of research that could potentially lead to earlier diagnosis as well as playing a part in assessing tumor response to therapy. Key words: Esophageal cancer; Esophageal cancer staging; Esophageal squamous cell carcinoma; Esophageal adenocarcinoma; Surgery Core tip: Esophageal carcinoma is a serious malignancy with regards to mortality and prognosis, and is expected to increase in incidence over the next 10 years. Squamous cell carcinoma is the most common histological type of esophageal cancer worldwide but the incidence of esophageal adenocarcinoma has dramatically increased in the past 40 years. Esophageal cancer is staged according to the TNM system. Common imaging modalities used in staging include computed tomography, endoscopic ultrasound and positron emission tomography scans. Current treatment options include multimodality therapy. Including surgery, radiation and chemotherapy. Tumor markers of esophageal cancer are an advancing area of research that could potentially lead to earlier diagnosis.Napier KJ, Scheerer M, Misra S. Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities. World J Gastrointest Oncol 2014; 6(5): 112-120 Available from:

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Section: Treatmentmentioning

confidence: 99%

Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities

Napier

Scheerer

Misra

2014

WJGO

690

604

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“…Barrett’s oesophagus is an acquired oesophageal condition characterized by the presence of metaplastic columnar epithelium in the distal oesophagus which replaces normal stratified squamous mucosa[ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is associated with prolonged gastro-oesophageal reflux and a risk of development of adenocarcinoma of the oesophagus[ 1 ]. Diagnosis is made by oesophagogastroduodenoscopy and biopsy sampling to allow histological examination of the oesophageal mucosa (Figure 1 ).…”

Section: Introductionmentioning

confidence: 99%

Barrett’s oesophagus: Current controversies

Amadi

Gatenby

2017

WJG

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Oesophageal adenocarcinoma is rapidly increasing in Western countries. This tumour frequently presents late in its course with metastatic disease and has a very poor prognosis. Barrett’s oesophagus is an acquired condition whereby the native squamous mucosa of the lower oesophagus is replaced by columnar epithelium following prolonged gastro-oesophageal reflux and is the recognised precursor lesion for oesophageal adenocarcinoma. There are multiple national and society guidelines regarding screening, surveillance and management of Barrett’s oesophagus, however all are limited regarding a clear evidence base for a well-demonstrated benefit and cost-effectiveness of surveillance, and robust risk stratification for patients to best use resources. Currently the accepted risk factors upon which surveillance intervals and interventions are based are Barrett’s segment length and histological interpretation of the systematic biopsies. Further patient risk factors including other demographic features, smoking, gender, obesity, ethnicity, patient age, biomarkers and endoscopic adjuncts remain under consideration and are discussed in full. Recent evidence has been published to support earlier endoscopic intervention by means of ablation of the metaplastic Barrett’s segment when the earliest signs of dysplasia are detected. Further work should concentrate on establishing better risk stratification and primary and secondary preventative strategies to reduce the risk of adenocarcinoma of the oesophagus.

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“…Barrett's oesophagus (BO) is characterised by the replacement of squamous epithelium in the oesophagus with specialised intestinal metaplasia and remains the strongest risk factor for oesophageal adenocarcinoma (OAC) . Acid suppressive medications such as proton pump inhibitors (PPIs) and H2 receptor antagonists (H2RAs) are commonly used medications to control gastro‐oesophageal reflux symptoms, with some recent data suggesting their use being associated with lower risk of progression to OAC .…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictors of osteoporotic fractures in patients with Barrett's oesophagus: a population‐based nested case‐control study

Kumar

Drake

Schleck

et al. 2017

Aliment Pharmacol Ther

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Summary BACKGROUND Proton pump inhibitors (PPI) are inconsistently associated with osteoporotic fractures. Barrett’s oesophagus patients are treated with high PPI doses for prolonged periods, but there is limited data on the incidence of osteoporosis and fractures in them. AIM In this study, we aimed to estimate the incidence of (and risk factors for) low bone mass (osteoporosis and/or osteopenia) related fractures in a population-based Barrett’s oesophagus cohort. METHODS All subjects with Barrett’s oesophagus and a diagnosis of osteoporosis and fractures were identified using Rochester Epidemiology Project (REP) resources. The incidence rates of all and osteoporotic fractures in these subjects were compared to an age- and gender similar population in Olmsted County to determine standardized incidence ratios (SIR). Predictors were assessed using Cox proportional hazards models. RESULTS Five hundred and twenty-one patients were included [median (IQR) age 61(52, 72) years; three hundred ninety-eight (76%) men] of whom one hundred thirteen (21.7%) had fractures, and forty-six (8.8%) had osteoporotic fractures. The incidence of all fractures and osteoporotic fractures was comparable to that of an age- and gender- matched population (SIR 1.09; 95% CI 0.92–1.29: SIR 1.05; 95% CI 0.85–1.29). PPI use, dose or duration of use was not associated with osteoporotic fracture risk (HR 0.87; 95% CI 0.12–6.39). Independent risk factors for osteoporotic fractures included older age, female gender and higher co-morbidity index. CONCLUSIONS The incidence of osteoporotic fractures was not increased in Barrett’s oesophagus patients compared to the general population. Additionally, PPI use was not associated with increased fracture risk regardless of the duration of therapy or dose.

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Diagnosis and Management of Barrett's Esophagus

Cited by 18 publications

References 118 publications

Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities

Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities

Barrett’s oesophagus: Current controversies

Incidence and predictors of osteoporotic fractures in patients with Barrett's oesophagus: a population‐based nested case‐control study

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