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Malignant Degeneration of Barrett’s Esophagus: Clinical Point of View

  • Conference paper
Esophageal Carcinoma

Part of the book series: Recent Results in Cancer Research ((RECENTCANCER,volume 155))

Abstract

The incidence of adenocarcinoma of the distal esophagus is increasing at an alarming rate. Intestinal metaplasia in the distal esophagus, i.e. Barrett’s esophagus, has been identified as the single most important risk factor for these tumors. Barrett’s esophagus develops as a consequence of chronic mucosal injury in up to 10% of patients with long-lasting gastroesophageal reflux disease. Experimental and clinical data indicate that adenocarcinoma of the distal esophagus is a direct consequence of mixed (i.e., acid and bile) reflux into the esophagus. Interestingly, Helicobacter pylori infection of the stomach appears to exert a protective effect against the development of esophageal adenocarcinoma. Neither aggressive medical acid suppression nor antireflux surgery can induce a predictable regression of Barrett’s esophagus or exert a protective effect against its malignant degeneration. Endoscopic ablation of Barrett’s esophagus, although appealing, currently constitutes a potentially dangerous procedure without proven benefit for the patient. Since the development of Barrett’s adenocarcinoma follows a multistep process from metaplasia through increasingly severe grades of dysplasia, close endoscopic surveillance with extensive biopsies currently remains the only means to identify patients at risk for malignant degeneration and detect esophageal adenocarcinoma at an early and curable stage.

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Author information

Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Ismaningerstr. 22, 81675, Munich, Germany

    H. J. Stein, M. Feith & J. R. Siewert

Authors
  1. H. J. Stein
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  2. M. Feith
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  3. J. R. Siewert
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Editors and Affiliations

  1. Klinik für Chirurgie, Kantonsspital St. Gallen, CH-90007, St. Gallen, Switzerland

    Jochen Lange

  2. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Germany

    J. R. Siewert

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© 2000 Springer-Verlag Berlin Heidelberg

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Stein, H.J., Feith, M., Siewert, J.R. (2000). Malignant Degeneration of Barrett’s Esophagus: Clinical Point of View. In: Lange, J., Siewert, J.R. (eds) Esophageal Carcinoma. Recent Results in Cancer Research, vol 155. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-59600-1_4

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  • DOI: https://doi.org/10.1007/978-3-642-59600-1_4

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-64044-5

  • Online ISBN: 978-3-642-59600-1

  • eBook Packages: Springer Book Archive

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