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Barrett’s Esophagus

Screening, Diagnosis, and Management

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Endoscopic Oncology

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Abstract

Barrett’s esophagus (BE) or columnar lined esophagus, is an acquired condition associated with chronic gastro-esophageal reflux disease (GERD). BE is strongly associated with GERD. Numerous endoscopic studies have demonstrated high rates of BE in patients with chronic GERD (1–3). It is a condition in which the normal stratified squamous epithelium of the tubular esophagus is replaced by a metaplastic columnar epithelium. The overriding concern for patients with BE is its malignant potential. BE is accepted as the precursor in most cases of esophageal adenocarcinoma. This malignancy has been linked to chronic GERD and obesity as has BE (4,5). Three case-control studies have demonstrated a strong association between adenocarcinoma of the esophagus and GERD (7–7). The incidence of this malignancy has been rising at a rate of 5–10% for the past three decades in western Europe and the United States, faster than any nondermatological malignancy (8). The Surveillance, Epidemiology, and End Results registry noted more than a 100% increase in the incidence of this tumor between 1976 and 1987 (9). The increasing incidence of esophageal adenocarcinoma appears to be continuing (10).

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References

  1. Winters C, Spurling TJ, Chobanian SJ, et al. Barrett’s esophagus: A prevalent occult complication of gastro-esophageal reflux disease. Gastroenterology 1987; 92:118-124.

    Google Scholar 

  2. Lieberman DA, Oehlke M, Helfand M, GORGE Consortium. Risk factors for Barrett’s esophagus in community-based practice. Am J Gastroenterol 1997; 92:1293–1297.

    PubMed  CAS  Google Scholar 

  3. Eisen GM, Sandler RS, Murray S, Gottfried M. The relationship between gastro-esophageal reflux disease and its complications with Barrett’s esophagus. Am J Gastroenterol 1997; 92:27–31.

    PubMed  CAS  Google Scholar 

  4. Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastro-esophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999; 340(11):825–831.

    Article  PubMed  CAS  Google Scholar 

  5. Lagergren J, Bergstrom R, Nyren O. Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann Int Med 1999; 130(11):883–890.

    PubMed  CAS  Google Scholar 

  6. Chow WH, Finkle WD, McLaughlin JK, Frankl H, Ziel HK, Fraument JFJr, The relation of gastro-esophageal reflux disease and its treatment to adenocarcinomas of the esophagus and gastric cardia. JAMA 1995; 274:474–477.

    Article  PubMed  CAS  Google Scholar 

  7. Farrow DC, Vaughan TL, Sweeney C, et al. Gastro-esophageal reflux disease, use of H2 receptor antagonists and risk of esophageal and gastric cancer. Cancer Causes Control 2000; 11:231–238.

    Article  PubMed  CAS  Google Scholar 

  8. Blot WJ, McLaughlin JK. The changing epidemiology of esophageal cancer. Semin Oncol 1999; 26(5 Suppl 15):2–8.

    PubMed  CAS  Google Scholar 

  9. Blot WJ, Devesa SS, Kneller RW, et al. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991; 265: 1287–1289.

    Article  PubMed  CAS  Google Scholar 

  10. Bollschweiler E, Wolfgraten E, Gutschow C, et al. Demographic variations in the rising incidence of esophageal adenocarcinoma in white males. Cancer 2001; 92:549–555.

    Article  PubMed  CAS  Google Scholar 

  11. Powell J, McConkey CC. The rising trend in oesophageal adenocarcinoma and gastric cardia. Eur J cancer Prev 1992; 1:265–269.

    Article  PubMed  CAS  Google Scholar 

  12. Hansson LE, Sparen P, Nyren O. Increasing incidence in both histological types of esophageal carcinoms among men in Sweden. Int J Cancer 1993; 54:402–407.

    Article  PubMed  CAS  Google Scholar 

  13. Sampliner RE. Adenocarcinoma of the esophagus and gastric cardia: is there progress in the face of increasing cancer incidence? Ann Int Med 1999; 130(1):67–69.

    PubMed  CAS  Google Scholar 

  14. Shaheen N, Ransohoff DF. Gastro-esophageal reflux, Barrett esophagus and esophageal cancer. Scientific Review. JAMA 2002; 287:1972–1981.

    Article  PubMed  Google Scholar 

  15. Falk GW. Barrett’s esophagus. Gastroenterology 2002; 122:1569–1591.

    Article  PubMed  Google Scholar 

  16. Cameron AJ, Zinsmeister AR, Ballard DJ, et al. Prevalence of columnar-lined (Barrett’s) esophagus. Comparison of population-based clinical and autopsy findings. Gastroenterology 1990; 99:918–922.

    PubMed  CAS  Google Scholar 

  17. Conio, M, Cameron AJ, Romero Y, et al. Secular tends in the epidemiology and outcome of Barrett’s oesophagus in Olmsted County, Minnesota. Gut 2001; 48:304–309.

    Article  PubMed  CAS  Google Scholar 

  18. Gerson LB, Shetler K, Triadafilopoulos G. Prevalence of Barrett’s esophagus in asymptomatic individuals. Gastroenterology 2002; 123(2):461–467.

    Article  PubMed  Google Scholar 

  19. Chak A, Lee T, Kinnard MF, et al. Familial aggregation of Barrett’s oesophagus, oesophageal adenocarcinoma and oesophagogastric junctional adenocarcinoma in Caucasian adults. Gut 2002; 51:323–328.

    Article  PubMed  CAS  Google Scholar 

  20. Romero Y, Cameron AJ, Locke GR3rd, et al. Familial aggregation of gastro-esophageal reflux in patients with Barrett’s esophagus and esophageal adenocarcinoma. Gastroenterology 1997; 113:1449–1456.

    Article  PubMed  CAS  Google Scholar 

  21. Spechler SJ, Goyal RK. Barrett’s esophagus. N Engl J Med 1986; 315:362–371.

    Article  PubMed  CAS  Google Scholar 

  22. Eisen G, Lieberman D, Fennerty MB, Sonnenberg A. Screening and surveillance in Barrett’s esophagus: a call to action. Clin Gastroenterol Hepatol. 2004; 2(10):861–864.

    Article  PubMed  Google Scholar 

  23. Drewitz DJ, Sampliner RE, Garewal HS. The incidence of adenocarcinoma in Barrett’s esophagus: a prospective study of 170 patients followed 4.8 years. Am J Gastroenterol 1997; 92(2):212–215.

    PubMed  CAS  Google Scholar 

  24. Shaheen NJ, Crosby MA, Bozymski EM, Sandler RS. Is there publication bias in the reporting of cancer risk in Barrett’s esophagus? Gastroenterology 2000; 119(2):333–338.

    Article  PubMed  CAS  Google Scholar 

  25. Sharma P, Morales TG, sampliner RE. Short segment Barrett’s esophagus—the need for standardization of the definition and endoscopic criteria. Am J Gastroenterol 1998; 93:1033–1036.

    PubMed  CAS  Google Scholar 

  26. Paull A, Trier JS, Dalton MD, et al. The histologic spectrum of Barrett’s esophagus. N Engl J Med 1976; 295:476–480.

    Article  PubMed  CAS  Google Scholar 

  27. Spechler SJ. Intestinal metaplasia at the gastro-esophageal junction. Gastroenterology 2004; 126(2):567–575.

    Article  PubMed  Google Scholar 

  28. Haggitt RC. Adenocarcinoma in Barrett’s esophagus: a new epidemic? Hum Pathol 1992; 23:475–476.

    Article  PubMed  CAS  Google Scholar 

  29. Eliakim R, Yassin K, Shlomi I, et al. A novel diagnostic tool for detecting oesophageal pathology: the Pill Cam oesophageal video capsule. Aliment Pharmacol Ther 2004; 20(10): 1083–1089.

    Article  PubMed  CAS  Google Scholar 

  30. Sorbi D, Gostout CJ, Henry J, Lindor KD. Unsedated small-caliber esophagogastroduodenoscopy (EGD) versus conventional EGD: a comparative study. Gastroenterology 1999; 117(6):1301–1307.

    Article  PubMed  CAS  Google Scholar 

  31. Falk GW, Chittajallu R, Goldblum R, et al. Surveillance of patients with Barrett’s esophagus for dysplasia and cancer with balloon cytology. Gastroenterology 1997; 112(6):1787–1797.

    Article  PubMed  CAS  Google Scholar 

  32. Falk GW, Rice TW, Goldblum JR, Richter JE. Jumbo biopsy forceps protocol still misses unsuspected cancer in Barrett’s esophagus with high-grade dysplasia. Gastrointest Endosc 1999; 49(2): 170–176.

    Article  PubMed  CAS  Google Scholar 

  33. Reid BJ, Blount PL, Rubin CE, et al. Flow cytometric and histological progression to malignancy in Barrett’s esophagus: prospective endoscopic surveillance of a cohort. Gastroenterology 1992; 102:1212–1219.

    PubMed  CAS  Google Scholar 

  34. Canto MI, Setrakian S, Petras R, et al. Methylene blue selectively stains intestinal metaplasia in Barrett’s esophagus. Gastrointest Endosc 1996; 44:1–6.

    Article  PubMed  CAS  Google Scholar 

  35. Yagi K, Nagamura A, Sekine A. Accuracy of magnifying endoscpy with methylene blue in the diagnosis of specialized intestinal metaplasia and short-segment Barrett’s esophagus in Japanese patients without Helicobacter pylori infection. Gastrointest Endosc 2003; 58–65.

    Google Scholar 

  36. Sharma P, Weston AP, Topalovski M, et al. Magnification chromoendoscopy for the detection of intestinal metaplssia and dysplasia in Barrett’s oesophagus. Gut 2003; 52:24–27.

    Article  PubMed  CAS  Google Scholar 

  37. Riddell RH, Goldman H, Ransohoff DF, et al. Dysplasia in inflammatory bowel disease: standardized classification with provisional clinical applications, Hum Pathol 1983; 14:931–968.

    Article  PubMed  CAS  Google Scholar 

  38. Montgomery E, Bronner MP, Goldblum JR, et al. Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation. Hum Pathol 2001; 32:368–378.

    Article  PubMed  CAS  Google Scholar 

  39. Alikhan M, Rex D, Khan A, et al. Variable pathologic interpretation of columnar lined esophagus by general pathologists in community practice. Gastrointest Endosc 1999; 50:23–26.

    Article  PubMed  CAS  Google Scholar 

  40. Sampliner RE. Updated guidelines for the diagnosis, surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol 2002; 97: 1888–1895.

    Article  PubMed  Google Scholar 

  41. Sharma P, McQuaid K, Dent J, et al. A critical review of the diagnosis and management of Barrett’s esophagus: the AGA Chicago workshop. Gastroenterology 2004; 127:310–330.

    Article  PubMed  Google Scholar 

  42. Provenzale D, Kemp JA, Arora S, et al. A guide for surveillance of patients with Barrett’s esophagus. Am J Gastroenterol 1994; 89:670–680.

    PubMed  CAS  Google Scholar 

  43. Inadomi JM, Sampliner R, Lagergren J, Lieberman D, Fendrick AM, Vakil N. Screening and surveillance for Barrett’s esophagus in highrisk populations: A cost-utility analysis. Ann Intern Med 2003; 138:176–186.

    PubMed  Google Scholar 

  44. Reid BJ, Levine DS, Longton G, et al. Predictors of progression to cancer in Barrett’s esophagus: baseline histology and flow cytometry identify low and high-risk patient subsets. Am J Gastroenterol 2000; 95:1669–1676.

    PubMed  CAS  Google Scholar 

  45. Buttar NS, Wang KK, Sebo TJ, et al. Extent of high grade dyaplasia in Barrett’s esophagus correlates with risk of adenocarcinoma. Gastroenterology 2001; 120:1630–1639.

    Article  PubMed  CAS  Google Scholar 

  46. Schnell TG, Sontag SJ, Chejfec G, et al. Long-term management of Barrett’s esophagus with high grade dysplasia. Gastroenterology 2001; 120:1607–1619.

    Article  PubMed  CAS  Google Scholar 

  47. Falk GW. Barrett’s esophagus. Gastroenterology 2002; 122:1569–1591.

    Article  PubMed  Google Scholar 

  48. Gore S, Healey CJ, Sutton R, et al. Regression of columnar lined (Barrett’s) oesophagus with continuous omeprazole therapy. Aliment Pharmacol Ther 1993; 7:623–628.

    Article  PubMed  CAS  Google Scholar 

  49. Sampliner RE, Garewal HS, Fennerty MB, Aickin M. Lack of impact of therapy on extent of Barrett’s esophagus in 67 patients. Dig Dis Sci 1990; 35:93–96.

    Article  PubMed  CAS  Google Scholar 

  50. Sharma P, Sampliner RE, Camargo E. Normalization of esophageal pH with high dose proton pump inhibitor therapy does not result in regression of Barrett’s esophagus. Am J Gastroenterol 1997; 92(4):582–585.

    PubMed  CAS  Google Scholar 

  51. Reid BJ, Levine DS, Longton G, Blount PL, Rabinovitch PS. Predictors of progression to cancer in Barrett’s esophagus: baseline histology and flow cytometry identify low-high risk patients subsets. Am J Gastroenterol 2000; 95:1669–1676.

    PubMed  CAS  Google Scholar 

  52. Schnell TG, Sontag SJ, Chejfec G, et al. Long-term nonsurgical management of Barrett’s esophagus with high grade dysplasia. Gastroenterology 2001; 120:1607–1619.

    Article  PubMed  CAS  Google Scholar 

  53. Pera M, Trastek VF, Carpenter HA, Allen MS, Deschamps C, Pairolero PC. Barrett’s esophagus with high grade dysplasia: an indication for esophagectomy? Ann Thorac Surg 1992; 54:199–204.

    Article  PubMed  CAS  Google Scholar 

  54. Rice TW, Falk GW, Achar E, Petras RE. Surgical management of high grade dysplasia in Barrett’s esophagus. Am J Gastroenterol 1993; 88:1832–1836.

    PubMed  CAS  Google Scholar 

  55. Daly JM, Fry WA, Little AG, et al. Esophageal cancer: results of an American College of Surgeons patient care evaluation study. J Am Col Surg 2000; 190:548–559.

    Google Scholar 

  56. Heitmiller RF, Redmond M. Hamilton SR. Barrett’s esophagus with high grade dysplasia. Ann Surg 1996; 224:66–71.

    Article  PubMed  CAS  Google Scholar 

  57. Cameron AJ, Lomboy CT. Barrett’s esophagus: age, prevalence, and extent of columnar epithelium. Gastroenterology 1992; 103:1241–1245.

    PubMed  CAS  Google Scholar 

  58. Sampliner RE, Hixson LJ, Fennerty MB, Garewal HS. Regression of Barrett’s esophagus by laser ablation in an anacid environment. Dig Dis Sci 1993; 38(2):365–368.

    Article  PubMed  CAS  Google Scholar 

  59. Jemal A, Murray T, Samuels A, Ghafoor A, Ward E, Thun MJ. Cancer Statistics 2003. CA Cancer J Clin 2003; 53:5–26.

    Article  PubMed  Google Scholar 

  60. Corley DA, Levin TR, Habel LA, Weiss NS, Buffler PA. Surveillance and survival in Barrett’s adenocarcinomas: A population-based study. Gastroenterology 2002; 122:633–640.

    Article  PubMed  Google Scholar 

  61. Dulai GS, Guha S, Kahn KL, Gornbein J, Weinstein WM. Preoperative prelvalence of Barrett’s esophagus in esophageal adenocarcinoma: A systematic review. Gastroenterology 2002; 122:26–33.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Gastroenterology, Oregon Health and Science University, Portland, OR

    Glenn M. Eisen MD, MPH

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  1. Glenn M. Eisen MD, MPH
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Editors and Affiliations

  1. Oregon Health and Science University, Portland, OR

    Douglas O. Faigel MD, FACG, FASGE (Associate Professor of Medicine, Director of Endoscopy) (Associate Professor of Medicine, Director of Endoscopy)

  2. Hospital of the University of Pennsylvania, Philadelphia, PA

    Michael L. Kochman MD, FACP, FASGE (Professor of Medicine and Surgery, Co-Director Gastrointestinal Oncology) (Professor of Medicine and Surgery, Co-Director Gastrointestinal Oncology)

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© 2006 Humana Press, Totowa, NJ

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Eisen, G.M. (2006). Barrett’s Esophagus. In: Faigel, D.O., Kochman, M.L. (eds) Endoscopic Oncology. Humana Press. https://doi.org/10.1007/978-1-59745-172-7_1

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  • DOI: https://doi.org/10.1007/978-1-59745-172-7_1

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-532-3

  • Online ISBN: 978-1-59745-172-7

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