research
Incidence and Risk Factors of Neoplastic Progression in Barrett’s Esophagus
- Publication date
- 1 January 2011
- Publisher
- Barrett’s esophagus (BE) is a condition in which the normal stratified squamous epithelium
lining the distal esophagus is replaced by columnar epithelium with specialized intestinal
metaplasia (IM) containing goblet cells. The development of BE is a complication of
chronic exposure to the gastric refluxate containing acid and bile.1-3 BE is a premalignant
condition which predisposes to the development of esophageal adenocarcinoma (EAC).
The development of this malignancy is a gradual stepwise process from no dysplasia (ND)
to low-grade dysplasia (LGD), high-grade dysplasia (HGD), and finally EAC.
During the past decades, the incidence of both BE5 and EAC has been rising rapidly
as demonstrated by a 7-fold increased incidence of EAC between 1973 and 2006.6-8 In
general, patients with BE have a 30- to 125-fold increased risk of developing EAC compared
to the general population. However, the annual incidence of EAC in BE patients
remains unclear, as it shows considerable variation among cohort studies, ranging from
0.2% to almost 3.5% per year. The consensus is however that the incidence of EAC
is approximately 0.5% per year.13 EAC usually has a poor prognosis and a high mortality
with a 5-year survival rate of less than 20%. As a result of the malignant potential of BE,
regular surveillance endoscopies are recommended in patients with BE. The intervals of
surveillance depend on the grade of dysplasia present. The goal of surveillance is to detect
neoplasia at an early stage, making early treatment with curative intention possible and
reducing death from EAC.