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Cancer Risk from Barrett's Esophagitis Has Probably Been Overstated

Posted Nov 03 2011 12:00am

A comprehensive retrospective study published in The New England Journal of Medicine has determined that the risk of esophageal cancer in Barrett’s esophagus patients is only about a fifth of what is currently believed to be the case (see: Cancer Risk From Barrett’s Esophagus Lower Than Thought ). If this new finding is integrated into cancer surveillance protocols, it may have a major effect on the practice of gastroenterology, given the high prevalence of GERD. Here is an excerpt from the article:

[Patients] with Barrett’s esophagus, which affects about a million Americans, have long been encouraged to undergo repeated, invasive screening tests to look for signs of cancer in the cells lining [it]. The condition was thought to make cancer of the esophagus up to 40 times as likely. But the new study found that the risk of esophageal cancer in Barrett’s patients was only about a fifth of what is currently believed. That suggests that the routine tests and endoscopies patients are subjected to may not be necessary in many cases....The study is by far the largest and most comprehensive to date on the subject....The study found that every year, 0.12 percent of the Barrett’s patients — or about one in 860 people — go on to develop cancer of the esophagus, a disease that is particularly lethal. The figure was much lower than the estimate of 0.5 percent stemming from earlier studies....According to current guidelines, people with Barrett’s should consider undergoing an endoscopy and biopsy of the esophageal lining about every three years. But the research suggests that Barrett’s patients may not need as many screening procedures. [The lead authors] said he believed endoscopies might be unnecessary after the first year except in cases where doctors find precancerous cells, a condition known as dysplasia, or when new symptoms occur. “Some people will have dysplasia, but that’s only 5 percent of the patients,” he said. “I don’t think the other 95 percent of the patients with no dysplasia need routine surveillance.“ An accompanying editorial agreed with that assessment, saying the problems with close surveillance of Barrett’s patients “lie in the numbers.”

The common condition of reflux esophagitis (GERD) occurs when gastric acid refluxes from the stomach into the distal esophagus. This causes metaplasia of the normal stratified squamous epithelium lining the distal esophagus to the columnar ephithelium normally occurring in the stomach (see: Barrett's esophagus ). If the latter then undergoes dysplastic change, this, in turn, can convert to adenocarcinoma in the distal esophagus. So, what I took away from this article is the following: if you have significant reflux, you should inquire about endoscopy to examine your esophagus and stomach. If no epithelial dysplasia is detected when biopsies are taken of the distal esophagus, no further surveillance is required. This is in contrast to the current guidelines that suggest continuing endoscopic surveillance about every three years.

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