Barrett's esophagus in 2008: an update

Area of Science:

• Gastroenterology and Oncology

Background:

• Esophageal adenocarcinoma (EA) has a rising incidence and poor prognosis.
• Barrett's esophagus is the primary precursor lesion for most EA cases.
• Population-based studies indicate a 1.6% prevalence of Barrett's esophagus, with many patients being asymptomatic.

Purpose of the Study:

• To enhance understanding of Barrett's esophagus and its progression to EA.
• To identify risk factors and predictive markers for EA development.
• To explore potential strategies for preventing EA progression.

Main Methods:

• Review of population-based analyses and risk factor identification.
• Evaluation of current markers (dysplasia) and emerging predictive measures (biomarkers, genetic instability).
• Assessment of potential therapeutic strategies including acid suppression and COX-2 inhibition.

Main Results:

• Identified risk factors for Barrett's esophagus include GERD, obesity, H. pylori eradication, and male gender.
• Progression rate from Barrett's to EA is estimated below 0.5% annually, with poor risk prediction.
• Endoscopic surveillance is standard for low-grade dysplasia; ablative therapies offer alternatives for high-grade dysplasia.

Conclusions:

• Barrett's esophagus management requires improved risk stratification beyond dysplasia.
• Biomarkers and genetic instability may offer better prediction of EA progression.
• Acid suppression and COX-2 inhibition warrant further investigation as preventative strategies.