Risk of malignant progression in patients with Barrett's oesophagus: a Dutch nationwide cohort study

Jonge, P.J.F. de; Blankenstein, M. van; Looman, Caspar W.N.; Casparie, Mariël K.; Meijer, Gerrit A.; Kuipers, Ernst J.

doi:10.1136/gut.2009.176701

Cited by 248 publications

(194 citation statements)

References 62 publications

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“…The incidence of BE is two to three times higher in men than women, and male sex is an independent risk factor for malignant transformation. The conservative estimate of the ten-year cumulative risk of EAC is 3-6% in the absence of dysplasia and 7-13% in the presence of low-grade dysplasia (26,27). On the other hand, high-grade dysplasia can be synonymous with microscopic adenocarcinoma in up to 40% of cases, especially if the Barrett's segment is nodular.…”

Section: Barrett's Esophagus (Be)mentioning

confidence: 99%

Overview of esophageal cancer

Abbas¹,

Krasna²

2017

Ann. Cardiothorac. Surg.

176

168

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Esophageal cancer is a male-dominant aggressive malignancy and a leading cause of cancer-related mortality worldwide. Squamous cell carcinoma and adenocarcinoma are the two predominant histological subtypes with varying geographical and racial distribution. Globally, squamous cell carcinoma remains the most common histological type. In Western countries, however, adenocarcinoma has become the leading histological subtype, corresponding to a rise in the incidence of obesity, gastro-esophageal reflux disease and Barrett's esophagus. The risk of esophageal adenocarcinoma conferred by Barrett's esophagus depends on factors such as genomic instability, race and gender of the patient. Treatment requires a multidisciplinary team approach and optimal therapy is still debated. Endoscopic therapies, including radiofrequency ablation, endoscopic mucosal resection and endoscopic sub mucosal dissection, have become the standard treatment modality for Barrett's esophagus and early carcinoma. Multimodal treatment, which includes chemotherapy, radiation therapy followed by surgical resection or without surgical resection, in varying orders remains the main mode of treatment for most patients. Minimally invasive surgical approaches have become the standard for esophagectomy and the current literature has demonstrated similar oncological outcomes with reduced morbidity. Recently, there has been a modest improvement in the overall survival of patients with esophageal cancer.

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Section: Barrett's Esophagus (Be)mentioning

confidence: 99%

Overview of esophageal cancer

Abbas¹,

Krasna²

2017

Ann. Cardiothorac. Surg.

176

168

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“…32 The prevalence of BE was lower in women than in men (Table). 7,19,[40][41][42][43][44][45][46][47][48][49][50][51] A systematic review after analyzing the PubMed database between 1997 and 2011 has shown that the prevalence of BE was lower in women than in men (28 out of 10 337, range 0.03-4.6% vs 70 out of 12 463, range 0.08-8.2%).…”

Section: Prevalence Of Barrett's Esophagusmentioning

confidence: 99%

Sex and Gender Differences in Gastroesophageal Reflux Disease

Kim

2016

J Neurogastroenterol Motil

122

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It is important to understand sex and gender-related differences in gastroesophageal reflux disease (GERD) because gender-related biologic factors might lead to better prevention and therapy. Non-erosive reflux disease (NERD) affects more women than men. GERD symptoms are more frequent in patients with NERD than in those with reflux esophagitis. However, men suffer pathologic diseases such as reflux esophagitis, Barrett's esophagus (BE), and esophageal adenocarcinoma (EAC) more frequently than women. The prevalence of reflux esophagitis is significantly increased with age in women, especially after their 50s. The mean age of EAC incidence in women is higher than in men, suggesting a role of estrogen in delaying the onset of BE and EAC. In a chronic rat reflux esophagitis model, nitric oxide was found to be an aggravating factor of esophageal injury in a male-predominant way. In addition, the expression of esophageal occludin, a tight junction protein that plays an important role in the esophageal defense mechanism, was up-regulated in women. This explains the male predominance of reflux esophagitis and delayed incidence of BE or EAC in women. Moreover, the symptoms such as heartburn, regurgitation, and extra-esophageal symptoms have been more frequently reported by women than by men, suggesting that sex and gender play a role in symptom perception. Differential sensitivity with augmented symptoms in women might have diagnostic and therapeutic influence. Furthermore, recent studies have suggested that hormone replacement therapy has a protective effect against esophageal cancer. However, an anti-inflammatory role of estrogen remains compelling, which means further study is necessary in this area.

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“…More recently, a large nationwide population-based cohort study in the Netherlands involving BE patients with histologically confirmed SIM revealed that the annual risk of EAC was 0.4 %, and after excluding HGD/EAC cases detected within 1 year after BE diagnosis, the incidence rates were 4.3/1,000 pyrs (95 % CI 3.4-5.5) for EAC and 5.8/1,000 pyrs (95 % CI 4.6-7.0) for HGD/EAC combined [67].…”

Section: Risk Factors For Eac or Dysplasiamentioning

confidence: 99%

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

Watari

Oshima

Fukui

et al. 2013

Clin J Gastroenterol

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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.

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Risk of malignant progression in patients with Barrett's oesophagus: a Dutch nationwide cohort study

Abstract: In this largest reported cohort of unselected patients with BO, the annual risk of OAC was 0.4%. Male sex, older age and LGD at diagnosis are independent predictors of malignant progression, and should enable an improved risk assessment in BO.

Cited by 248 publications

References 62 publications

Overview of esophageal cancer

Overview of esophageal cancer

Sex and Gender Differences in Gastroesophageal Reflux Disease

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

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