Barrett's Esophagus in 2008 : an Update

概要

論文の詳細を見る
With the rising incidence and overall poor prognosis of esophageal adenocarcinoma (EA) there is great interest in furthering our understanding of Barretts esophagus, the precursor lesion for most cases of EA. The best available evidence from true population-based analysis suggests that the prevalence of Barretts is 1.6%. In addition, nearly half of the patients with Barretts are asymptomatic. Several risk factors for development of Barretts have been identified including gastro-esophageal reflux disease (GERD), central obesity, H. pylori eradication, and male gender. The precise incidence of progression from Barretts to esophageal adenocarcinoma is not known, but it probably is less than 0.5% per year, and our ability to predict who is at highest risk for progression remains poor. The degree of dysplasia is currently used as a marker for risk of progression to cancer though there is increasing evidence that biomarkers and level of genetic instability may provide better predictive measures. Intensive acid-suppression and COX-2 inhibition are potential strategies to reduce the risk of progression, though definitive studies are needed. Endoscopic surveillance remains the mainstay of management for non-dysplastic and low grade dysplasia Barretts. The advent of various endoscopic ablative therapies has provided a promising alternative to surgery for Barretts patients with high grade dysplasia (HGD).
The Keio Journal of Medicineの論文
2008-09-01