TY - JOUR
T1 - Barrett oesophagus
AU - Peters, Yonne
AU - Al-Kaabi, Ali
AU - Shaheen, Nicholas J.
AU - Chak, Amitabh
AU - Blum, Andrew
AU - Souza, Rhonda F.
AU - Di Pietro, Massimiliano
AU - Iyer, Prasad G.
AU - Pech, Oliver
AU - Fitzgerald, Rebecca C.
AU - Siersema, Peter D.
N1 - Funding Information:
N.J.S. has received research grants from Medtronic, CSA Medical, C2 Therapeutics, CDx Medical, EndoStim and Interpace Diagnostics and has served as a consultant for Pfizer, Boston Scientific and Shire. A.C. has equity interest in and is a consultant for Lucid Diagnostics. R.F.S. has served as a consultant and receives research support from Ironwood Pharmaceuticals. M.D.P. has received educational grants from Olympus and Medtronic and has served as consultant for Medtronic. P.G.I. has received research funding from Exact Sciences, Pentax Medical, Symple Surgical, Nine Point Medical and Medtronic and has served as a consultant for Medtronic, Symple Surgical and CSA Medical. O.P. has a speaker honorarium from Olympus, Fujifilm, Medtronic, Boston Scientific and Cook. R.C.F. is named on patents related to the Cytosponge and associated assays, which have been licensed to Covidien (now Medtronic), and has served as a consultant to Medtronic. P.D.S. has received research funding from Pentax Medical, EndoStim, Yakult, OncoDNA and Ella-CS. Y.P., A.A.-K. and A.B. declare no competing interests.
Publisher Copyright:
© 2019, Springer Nature Limited.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Barrett oesophagus (BE), the only known histological precursor of oesophageal adenocarcinoma (EAC), is a condition in which the squamous epithelium of the oesophagus is replaced by columnar epithelium as an adaptive response to gastro-oesophageal reflux. EAC has one of the fastest rising incidences of cancers in Western countries and has a dismal prognosis. BE is usually detected during endoscopic examination, and diagnosis is confirmed by the histological presence of intestinal metaplasia. Advances in genomics and transcriptomics have improved our understanding of the pathogenesis and malignant progression of intestinal metaplasia. As the majority of EAC cases are diagnosed in individuals without a known history of BE, screening for BE could potentially decrease disease-related mortality. Owing to the pre-malignant nature of BE, endoscopic surveillance of patients with BE is imperative for early detection and treatment of dysplasia to prevent further progression to invasive EAC. Developments in endoscopic therapy have resulted in a major shift in the treatment of patients with BE who have dysplasia or early EAC, from surgical resection to endoscopic resection and ablation. In addition to symptom control by optimization of lifestyle and pharmacological therapy with proton pump inhibitors, chemopreventive strategies based on NSAIDs and statins are currently being investigated for BE management.
AB - Barrett oesophagus (BE), the only known histological precursor of oesophageal adenocarcinoma (EAC), is a condition in which the squamous epithelium of the oesophagus is replaced by columnar epithelium as an adaptive response to gastro-oesophageal reflux. EAC has one of the fastest rising incidences of cancers in Western countries and has a dismal prognosis. BE is usually detected during endoscopic examination, and diagnosis is confirmed by the histological presence of intestinal metaplasia. Advances in genomics and transcriptomics have improved our understanding of the pathogenesis and malignant progression of intestinal metaplasia. As the majority of EAC cases are diagnosed in individuals without a known history of BE, screening for BE could potentially decrease disease-related mortality. Owing to the pre-malignant nature of BE, endoscopic surveillance of patients with BE is imperative for early detection and treatment of dysplasia to prevent further progression to invasive EAC. Developments in endoscopic therapy have resulted in a major shift in the treatment of patients with BE who have dysplasia or early EAC, from surgical resection to endoscopic resection and ablation. In addition to symptom control by optimization of lifestyle and pharmacological therapy with proton pump inhibitors, chemopreventive strategies based on NSAIDs and statins are currently being investigated for BE management.
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U2 - 10.1038/s41572-019-0086-z
DO - 10.1038/s41572-019-0086-z
M3 - Review article
C2 - 31123267
AN - SCOPUS:85066864044
SN - 2056-676X
VL - 5
JO - Nature Reviews Disease Primers
JF - Nature Reviews Disease Primers
IS - 1
M1 - 35
ER -