No Barrett-No Cancer: A Proposed New Paradigm for Prevention of Esophageal Adenocarcinoma.

07:00 EST 16th December 2019 | BioPortfolio

Summary of "No Barrett-No Cancer: A Proposed New Paradigm for Prevention of Esophageal Adenocarcinoma."

Esophageal adenocarcinoma is inflammation-associated cancer with a recognizable preneoplastic stage, Barrett esophagus. Barrett esophagus describes the metaplastic transformation of esophageal squamous mucosa into columnar epithelium that typically results secondary to mucosal damage caused by acidic gastroduodenal reflux. Continued acid reflux may then result in mucosal inflammation which results in progressive inflammation-induced genetic instability that may eventuate in esophageal adenocarcinoma. Barrett esophagus is the only recognized precursor lesion to esophageal carcinoma. Barrett mucosa is unique among preneoplastic lesions; ablation therapy results in restitution of a squamous epithelium reducing or eliminating accumulated genetic instabilities and resetting the biological clock progressing toward invasive cancer. However, recurrence of Barrett after ablation is common. We propose that both Barrett and recurrence of Barrett after ablation can be prevented and discuss how current approaches to therapy for gastroesophageal reflux disease, for Barrett screening, chemoprevention, and ablation therapy all might be reconsidered. We propose (1) improved approaches to Barrett prevention, (2) universal Barrett screening by linking Barrett screening to colon cancer screening, (3) ablation of all Barrett mucosa along with (4) acid-suppressive-antireflux therapy tailored to prevent development of Barrett or the recurrence of Barrett after ablation therapy. We propose that ultimately, treatment decisions for gastroesophageal reflux disease and prevention of Barrett esophagus and esophageal carcinoma should be based on assessing and maintaining esophageal mucosal integrity. This will require development and verification of specific measurements that reliably correlate with prevention of Barrett esophagus. We outline the new research and technical advances needed to cost-effectively achieve these goals.


Journal Details

This article was published in the following journal.

Name: Journal of clinical gastroenterology
ISSN: 1539-2031


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Medical and Biotech [MESH] Definitions

A condition with damage to the lining of the lower ESOPHAGUS resulting from chronic acid reflux (ESOPHAGITIS, REFLUX). Through the process of metaplasia, the squamous cells are replaced by a columnar epithelium with cells resembling those of the INTESTINE or the salmon-pink mucosa of the STOMACH. Barrett's columnar epithelium is a marker for severe reflux and precursor to ADENOCARCINOMA of the esophagus.

An adenocarcinoma characterized by the presence of varying combinations of clear and hobnail-shaped tumor cells. There are three predominant patterns described as tubulocystic, solid, and papillary. These tumors, usually located in the female reproductive organs, have been seen more frequently in young women since 1970 as a result of the association with intrauterine exposure to diethylstilbestrol. (From Holland et al., Cancer Medicine, 3d ed)

A voluntary organization concerned with the prevention and treatment of cancer through education and research.

A lesion with cytological characteristics associated with invasive adenocarcinoma but the tumor cells are confined to the GLANDULAR EPITHELIAL CELLS of origin. Adenocarcinoma in situ of the CERVIX and the LUNG are the most common.

Tumors or cancer of the ESOPHAGUS.

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