Barrett’s esophagus and its progression to cancer

Presented in 12th Emirates pathology, digital pathology Conference Holiday Inn Dubai, Al Barsha, UAE & Virtual
Speaker Name: Dr. Fatema Tasnim (USA)
Category: Poster Presentation

Dr. Fatema Tasnim graduated from Sir Salimullah Medical College under University of Dhaka. She did her postgraduation in biochemistry from Bangabandhu Sheikh Mujib Medical University. She is currently a Ph. D. student of Pharmacology in Long Island University. She has great interest in pathology and wants to pursue research in the area of cancer.
Barrett’s esophagus, or columnar lined esophagus, is an acquired condition that results from chronic gastro-esophageal reflux. It is characterized by the metaplastic replacement of the normal squamous epithelium of the lower esophagus by columnar epithelium. The diagnosis of Barrett’s esophagus is made on endoscopy, but it has to be confirmed by the histological examination of biopsies, which show the characteristic incomplete intestinal metaplasia (also called ‘‘specialized’’ mucosa). Barrett’s esophagus is a premalignant condition that predisposes to the development of esophageal adenocarcinoma, a tumor with an increasing frequency in most Western countries. Barrett’s esophagus develops in 5–20% of patients with gastroesophageal reflux disease and predisposes to esophageal adenocarcinoma. In view of the increasing incidence of esophageal adenocarcinoma in the western world, it is important that more attention be paid to the progression of Barrett’s esophagus toward esophageal adenocarcinoma.

Figure: Molecular pathways leading to the progression of Barrett’s esophagus to adenocarcinoma.
Blue arrows indicate activation, red arrows therapeutic inhibition BMP, bone morphogenetic protein; GERD, gastro-esophageal reflux disease; RA, retinoic acid signaling pathway; PPI, proton pump inhibitor; HH, hedgehog signaling pathway; WNT, winglesstype MMTV integration site family; UDCA, ursodeoxycholic acid; NSAIDs, non-steroid anti-inflammatory drugs For prevention of progression of Barrett cells into cancer, it seems patients who are taking proton pump inhibitors may have lower rates of progression than those who use H2 blockers or no other medication. Similarly, the use of statins is associated with a lower risk of progression of Barrett esophagus in some studies. The most likely effective step in preventing cancer in patients with Barrett esophagus and dysplasia is endoscopic eradication therapy. Multiple studies suggest that there is a greater than 90% risk reduction of developing cancer after successful ablation for Barrett esophagus.

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2. Nele Schoofs, Raf Bisschops, Hans Prenen; Progression of Barrett’s esophagus toward esophageal adenocarcinoma: an overview; Annals of Gastroenterology (2017) 30, 1-6
3. Brian J. Reid, M.D., Ph.D., Douglas S. Levine, M.D., Gary Longton, M.S., Patricia L. Blount, M.D., and Peter S. Rabinovitch, M.D., Ph.D.; Predictors of Progression to Cancer in Barrett’s Esophagus: Baseline Histology and Flow Cytometry Identify Low- and HighRisk Patient Subsets; Am J Gastroenterol. 2000 July ; 95(7): 1669–1676
4. Shivaram Bhat, Helen G. Coleman, Fouad Yousef, Brian T. Johnston, Damian T. McManus, Anna T. Gavin, Liam J. Murray; Risk of Malignant Progression in Barrett’s Esophagus Patients: Results from a Large Population-Based Study; JNCI; Vol. 103, Issue 13 | July 6, 2011;1049-1057
5. J-F Fle´jou; Barrett’s oesophagus: from metaplasia to dysplasia and cancer; Gut 2005; 54(Suppl I):i6–i12

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