Recent advances in Barrett's esophagus

Inadomi, John M.; Alastal, Hani; Bonavina, Luigi; Gross, Seth A.; Hunt, Richard H.; Mashimo, Hiroshi; Pietro, Massimiliano di; Rhee, Horace; Shah, Marmy; Tolone, Salvatore; Wang, David H.; Xie, Shao-Hua

doi:10.1111/nyas.13909

Cited by 15 publications

(17 citation statements)

References 101 publications

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“…To further enhance the antireflux barrier, a crural diaphragmatic repair is routinely added 7 . Currently, the fact that fundoplication is offered to less than 1% of the GERD population may have an impact on the progression of symptoms and the development of Barrett’s esophagus 8 .…”

Section: Introductionmentioning

confidence: 99%

Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease

Ferrari

Asti

Lazzari

et al. 2020

Sci Rep

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The magnetic sphincter augmentation (MSA) device has been proven safe and effective in controlling typical reflux symptoms and esophageal acid exposure for up to 6-year follow-up. Longer term outcomes have not been reported yet. A prospectively maintained database was reviewed to assess long-term safety and efficacy of the laparoscopic MSA procedure at a single referral center. Gastro-Esophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL), use of proton-pump inhibitors (PPI), and esophageal acid exposure were compared to baseline. Favorable outcomes were defined as ≥ 50% improvement of GERD-HRQL total score and PPI discontinuation. Between March 2007 and March 2020, 335 patients met the study inclusion criteria, and 124 of them were followed from 6 to 12 years after surgery (median 9 years, IQR 2). Mean total GERD-HRQL score significantly improved from 19.9 to 4.01 (p < 0.001), and PPI were discontinued by 79% of patients. The mean total percent time with pH < 4 decreased from 9.6% at baseline to 4.1% (p < 0.001), with 89% of patients achieving pH normalization. Independent predictors of a favorable outcome were age at intervention < 40 years (OR 4.17) and GERD-HRQL score > 15 (OR 4.09). We confirm long-term safety and efficacy of MSA in terms of symptom improvement, decreased drug dependency, and reduced esophageal acid exposure. The global burden of gastroesophageal reflux disease (GERD) is enormous, with a pooled prevalence of 13.3% in community-based studies 1. Symptoms and complications of GERD persist in up to 40% of patients treated with proton-pump inhibitors (PPI) 2,3 , and fundoplication is largely underused because of the steep learning curve and reported variability in outcomes 4. The aim of fundoplication is to restore lower esophageal sphincter (LES) function by remodeling the esophagogastric junction 5. Both total (Nissen) and partial (Toupet) fundoplication procedures require mobilization of the gastric fundus to be wrapped around the distal esophagus 6. To further enhance the antireflux barrier, a crural diaphragmatic repair is routinely added 7. Currently, the fact that fundoplication is offered to less than 1% of the GERD population may have an impact on the progression of symptoms and the development of Barrett's esophagus 8. The magnetic sphincter augmentation (MSA) procedure (Linx Reflux Management System, Ethicon, Johnson & Johnson, Shoreview, Mn, USA) was developed as a less disruptive and more standardized and reproducible laparoscopic surgical option for the treatment of GERD. The MSA device is composed by a variable number of interlinked titanium beads with a magnetic core inside. This ring-like system produces a magnetic force that augments the LES. The first feasibility trial and a large prospective nonrandomized study were published in 2008 9 and 2013 10 , respectively. The MSA procedure has been granted approval for clinical use by the Food and Drug Administration in 2012. Previous reports from our group have shown feasibility, safety, and efficacy of the MSA procedure...

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Section: Introductionmentioning

confidence: 99%

Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease

Ferrari

Asti

Lazzari

et al. 2020

Sci Rep

Self Cite

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“…Our data suggest that per pg/mL increase in the natural logarithm of plasma concentration of BMP5, the odds of having BE increases by 50%. 29,30 . Since BMP5 was the most promising BMP associated with the risk of developing BE, we subsequently performed multivariate analyses of different known risk factors associated with BE together with plasma levels of BMP5 (Table 4).…”

Section: Study Population and Patient Characteristicsmentioning

confidence: 99%

Detection of circulating BMP5 as a risk factor for Barrett’s esophagus

Correia

Calpe

Mostafavi

et al. 2020

Sci Rep

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Barrett’s esophagus (BE) predisposes for the malignant condition of esophageal adenocarcinoma (EAC). Since BE patients have few or no symptoms, most of these patients are not identified and not included in surveillance programs. These BE patients are at risk of developing advanced-stage EAC. At present, non-invasive tests to identify BE patients from the general population are lacking. We and others showed that Bone Morphogenetic Protein 4 (BMP4), and other BMPs are upregulated in BE. We aimed to determine if circulating BMPs can be identified and used as blood biomarkers to identify BE patients at high risk in the general population. In this study, we could detect the different BMPs in the blood of 112 BE patients and 134 age- and sex-matched controls. Concentration levels of BMP2, BMP4, and BMP5 were elevated in BE patients, with BMP2 and BMP5 significantly increased. BMP5 remained significant after multivariate analysis and was associated with an increased risk for BE with an OR of 1.49 (p value 0.01). Per log (pg/mL) of BMP5, the odds of having BE increased by 50%. Future optimization and validation studies might be needed to prove its utility as a non-invasive method for the detection of BE in high-risk populations and screening programs.

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“…Direct extension of gastric cells adjacent to the esophagus, reprogramming of squamous stem cells or repopulation from submucosal esophageal glands are discussed as origin of the metaplastic columnar Barrett's epithelium (10). Traditionally, acid reflux was considered playing the main role in the pathogenesis of BE (11). However, evidence is growing that rather chronic, cytokine mediated inflammation of the distal esophagus than chemical injury from acid reflux alone is significant for the development of metaplastic epithelium (12,13).…”

Section: Pathogenesis Of Barrett Developmentmentioning

confidence: 99%

Does anti-reflux surgery disrupt the pathway of Barrett’s esophagus progression to cancer?

Schoppmann¹,

Kristo²,

Riegler³

2018

Transl. Gastroenterol. Hepatol

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In patients with Barrett's esophagus (BE), anti-reflux surgery aims to sustainable control reflux symptoms and heal reflux induced esophageal mucosal inflammation and prevent progression of BE to adenocarcinoma. There is growing evidence that beside gastric acid, bile salts in refluxed duodenal juice are responsible for the development and progression of BE. However, the pathogenesis of BE progression and the metaplasia-dysplasia-carcinoma sequence of the adenocarcinoma of the esophagus (EAC) is multifactorial and occurs over long natural time course. After anti-reflux surgery significant levels of regression from metaplastic Barrett's to non-metaplastic epithelium as well as from dysplastic to non-dysplastic BE have been observed and a randomized trial showed that sufficient surgical reflux control reduces the risk of Barrett's progression significantly when compared to medical treatment. Thus, large cohort studies show significant reduced risk of EAC in patients suffering from gastroesophageal reflux disease (GERD) with and without BE after anti-reflux surgery. Even after anti-reflux surgery the risk for EAC remains elevated in patients with BE and the right moment of intercepting the progressive nature of GERD has to be discussed in future. The paper also addresses the impact of anti-reflux surgery, endoscopic ablation and life style therapies for the management of GERD, BE and cancer prevention.

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Recent advances in Barrett's esophagus

Cited by 15 publications

References 101 publications

Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease

Six to 12-year outcomes of magnetic sphincter augmentation for gastroesophageal reflux disease

Detection of circulating BMP5 as a risk factor for Barrett’s esophagus

Does anti-reflux surgery disrupt the pathway of Barrett’s esophagus progression to cancer?

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