Gastroesophageal reflux disease, Barrett esophagus, and esophageal adenocarcinoma – where do we stand?

Mikolašević, Ivana; Bokun, Tomislav; Kanižaj, Tajana Filipec

doi:10.3325/cmj.2018.59.97

Cited by 6 publications

(6 citation statements)

References 12 publications

(36 reference statements)

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“…In our cohort, demographic and lifestyle factors, including age at diagnosis of IND, sex, history of tobacco and alcohol use and BMI, were not significantly different between progressors and non‐progressors. This finding is consistent with prior observations that older age, male, white ethnicity, tobacco use and waist circumference have been identified as risk factors for the development of BE only, but not necessarily for neoplastic progression from IND to higher‐grade dysplasia 31,32 …”

Section: Discussionsupporting

confidence: 93%

“…This finding is consistent with prior observations that older age, male, white ethnicity, tobacco use and waist circumference have been identified as risk factors for the development of BE only, but not necessarily for neoplastic progression from IND to higher-grade dysplasia. 31,32 Another risk factor reported to be specific for disease progression is length of BE segment, 5,33,34 however; we did not observe significant differences between progressors and non-progressors. The recently updated guidelines from the American College of Gastroenterology (ACG) recommend a 3-year surveillance interval for long-segment Barrett oesophagus (LSBE) and a 5-year interval for short-segment Barrett oesophagus (SSBE).…”

Section: Discussioncontrasting

confidence: 53%

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Aberrant p53 expression is associated with neoplastic progression in Barrett oesophagus diagnosed as indefinite for dysplasia

et al. 2022

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Aberrant p53 expression is associated with neoplastic progression in Barrett oesophagus diagnosed as indefinite for dysplasiaThe aim of this study was to investigate the role of immunohistochemical (IHC) expression of p53 and other potential clinical parameters as prognostic markers for predicting neoplastic progression in Barrett oesophagus (BE) patients diagnosed as indefinite for dysplasia (IND). The study included patients with established BE of any extent who had a diagnosis of IND accompanied by concurrent p53 immunohistochemistry (IHC) stain at the index endoscopic procedure and at least one follow-up examination between 2000 and 2021. Correlation between disease progression from IND to higher-grade dysplasia [low-grade dysplasia (LGD), high-grade dysplasia (HGD) and oesophageal adenocarcinoma (EAC)] and clinicopathological parameters were analysed. A total of 149 patients (99 males; mean age 63.3 AE 10.0 years, range = 35-89) were included in the final analysis. Median follow-up was 37.1 months [interquartile range (IQR) = 20.5-59.1 months]. Progression rates from IND to LGD and HGD were 12.1% (18 of 149) and 2.7% (four of 149), respectively. On multivariate analysis, the number of IND diagnoses was significantly associated with progression to both LGD and HGD (P = 0.016 and P < 0.001, respectively). Cox regression analysis showed that aberrant p53 expression was significantly associated with progression to LGD [hazard ratio (HR) = 4.87, 95% confidence interval (CI) = 1.91-12.45, P = 0.001] and HGD (HR = 21.81, 95% CI = 1.88-253.70, P = 0.014). Kaplan-Meier survival analysis also demonstrated that aberrant p53 expression was significantly associated with progression to LGD (P < 0.001) and HGD (P = 0.001). Our results suggest that frequency of IND diagnoses and status of p53 expression can help to stratify risk of neoplastic progression in BE patients with IND.

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Section: Discussionsupporting

confidence: 93%

Section: Discussioncontrasting

confidence: 53%

Aberrant p53 expression is associated with neoplastic progression in Barrett oesophagus diagnosed as indefinite for dysplasia

et al. 2022

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“…According to data, about 25% of all cancers are in the gastrointestinal tract (GIT), making it the dominant cancer affected site [ 1 ]. As it is the case with most human tumors, esophageal carcinoma (EAC) is preceded by premalignant lesion or Barrett esophagus (BE).…”

Section: Introductionmentioning

confidence: 99%

“…e main characteristic of BE is abnormal transformation of the squamous epithelium. Gastroesophageal reflux disease (GERD) is one of the most common GIT-related diseases worldwide and one of the most common indications for visiting gastroenterologists [1][2][3][4][5][6][7]. In the context of GERD, reflux of stomach contents into esophagus is responsible for the most common symptoms of this condition: heartburn, regurgitation, and dysphagia.…”

Section: Introductionmentioning

confidence: 99%

Association between Gastroesophageal Reflux Disease and Elastographic Parameters of Liver Steatosis and Fibrosis: Controlled Attenuation Parameter and Liver Stiffness Measurements

Mikolašević

Poropat

Kanižaj

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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Aim. Our aim was to investigate the association among elastographic parameters of liver steatosis and fibrosis, controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), with gastroesophageal reflux disease (GERD). Methods. In this prospective, cross-sectional study, we have evaluated 937 patients with one or more components of the metabolic syndrome who had an esophagogastroduodenoscopy (EGD) due to GERD symptoms. In all patients, a laboratory analysis, an abdominal ultrasound, and FibroScan measurements were done. GERD was defined by EGD. Results. The mean body mass index (BMI) of the study population was 30.95 ± 5.45 kg/m2. The prevalence of increased CAP was 82.6% (774/937). Patients with increased CAP were younger, were more obese, had higher prevalence of hypertension, diabetes, and dyslipidemia, and had higher values of aminotransferases. Similar results of higher prevalence in patients with elevated CAP were observed with GERD, hiatal hernia, and insufficient cardia (defined as deficient or absent closure of the gastric inlet in relation to the esophagus). Additionally, patients with elevated CAP had a higher prevalence of GERD grades B and C in comparison to those without elevated CAP. Consequently, patients who did not have elevated CAP had a higher prevalence of GERD grade A. Even though we have found an upward trend in the prevalence of GERD, hiatal hernia, and insufficient cardia, there was no significant difference between subjects with fibrosis (F) 1-2 and F3-4 stage of fibrosis or F1 and F2-4. In a binary logistic regression, a significant positive association with GERD was obtained for CAP. Furthermore, a significant positive association with hiatal hernia was obtained for BMI and CAP. Finally, a significant positive association with hiatal hernia was obtained with CAP in multivariate analysis. Conclusion. To the best of our knowledge, our study is the first to reveal a positive association between CAP as a surrogate marker of liver steatosis and GERD after adjustments for other clinical variables.

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“…Multiple observational studies have shown that GERD increases the risk of EC, [ 26 , 27 ] and GERD has been associated with the development of EC. Specifically, the duration of GERD is positively associated with the risk of EAC.…”

Section: Discussionmentioning

confidence: 99%

Causal analysis of gastroesophageal reflux disease and esophageal cancer

Wang,

Li,

Zhou

et al. 2024

Medicine

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Patients with gastroesophageal reflux disease (GERD) are more likely to develop esophageal cancer (EC). However, a causal relationship between the 2 has been difficult to determine. Therefore, this study aimed to evaluate the impact of GERD on EC using the Mendelian randomization (MR) method. The causal association between GERD and EC was analyzed based on 2 publicly available genetic summary datasets for the GERD cohort (129,080 cases vs 473,524 controls) and the EC cohort (740 cases vs 372,016 controls). The causal inference was mainly evaluated by the inverse variance weighted MR. The MR-Egger regression, MR Pleiotropy Residual Sum and Outlier test, and leave-one-out test were used to confirm the sensitivity of the MR results. Possible interfering factors were excluded by multivariate MR (MVMR) analysis. We used 73 single nucleotide polymorphisms as instrumental variables. GERD was associated with increasing EC risk (odds ratio [OR], 1.001; 95% confidence interval, 1.001–1.002; P < .001), which was identified using the inverse variance weighted method. The sensitivity analysis also demonstrated similar results with the causal explanation, and major bias in genetic pleiotropy was not identified (intercept, 0.001; standard error, 0.001; P = .418). The multivariate MR analysis demonstrated the effect of GERD on EC even after excluding possible mediating factors (OR, 1.003; 95% confidence interval, 1.001–1.005; P = .012). This study confirmed that GERD has a causal effect on EC. Therefore, interventional measures are recommended to prevent EC.

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Gastroesophageal reflux disease, Barrett esophagus, and esophageal adenocarcinoma – where do we stand?

Cited by 6 publications

References 12 publications

Aberrant p53 expression is associated with neoplastic progression in Barrett oesophagus diagnosed as indefinite for dysplasia

Aberrant p53 expression is associated with neoplastic progression in Barrett oesophagus diagnosed as indefinite for dysplasia

Association between Gastroesophageal Reflux Disease and Elastographic Parameters of Liver Steatosis and Fibrosis: Controlled Attenuation Parameter and Liver Stiffness Measurements

Causal analysis of gastroesophageal reflux disease and esophageal cancer

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