- Email: [email protected]
Barrett's esophagus, Part II: treatment
Gastrointest Endoscopy Clin N Am 13 (2003) xiii – xiv
Preface
Barrett’s esophagus, Part II: treatment
Prateek Sharma, MD Guest Editor
The rise in the incidence of esophageal adenocarcinoma has been witnessed in the United States and in the entire western world. Mortality rates from this cancer have paralleled this increase in incidence. Barrett’s esophagus as a premalignant lesion is recognized in the majority of cases of adenocarcinoma of the esophagus and esophagogastric junction. Increasing attention has recently been focused on the diagnosis and treatment of Barrett’s esophagus with attempts to reverse the lesion, and alter the progression to dysplasia and adenocarcinoma. The current treatment of patients with Barrett’s esophagus is aimed at reducing esophageal acid exposure by proton pump inhibitor therapy or by antireflux surgery. Although reflux symptoms are significantly improved in patients with Barrett’s esophagus by acid-reducing therapies, their impact on neoplastic progression has yet to be demonstrated in clinical trials. Use of aspirin or other selective/nonselective cyclo-oxygenase inhibitors as an adjunct to acid reduction therapy appears to hold promise as a chemotherapeutic strategy. Use of various tools to ‘‘ablate’’ Barrett’s mucosa have consistently shown subsquamous regrowth/persistence of metaplasia and occasionally also of dysplastic/cancerous tissue. These endoscopic techniques, however, can probably play a role in subgroups of patients with high-grade dysplasia or early adenocarcinoma. Clearly we have a long way to go before cancer-reducing strategies can be applied to all patients with Barrett’s esophagus. A previous issue of the Gastrointestinal Endoscopy Clinics of North America discussed the epidemiology, endoscopic diagnosis, and alternative methods for diagnosis of intestinal metaplasia, dysplasia, and cancer. In this issue, the controversies surrounding the use of endoscopic techniques as well as medical and surgical interventions are discussed eloquently by leaders in the Barrett’s 1052-5157/03/$ – see front matter D 2003 Elsevier Inc. All rights reserved. doi:10.1016/S1052-5157(03)00045-X
xiv
P. Sharma / Gastrointest Endoscopy Clin N Am 13 (2003) xiii–xiv
arena. All of the authors have provided in-depth reviews of their topics that contain extremely useful clinical information. This should provide clinicians with a better and informed understanding about the various approaches to treatment of patients with Barrett’s esophagus and esophageal cancer. Once again, I would like to thank all the authors for their efforts and to Mary Mackison and Kerry Holland for their help with the preparation of this issue. Prateek Sharma, MD Division of Gastroenterology and Hepatology University of Kansas School of Medicine VA Medical Center Kansas City, MO 64128, USA E-mail address: [email protected]
Preface
Barrett’s esophagus, Part II: treatment
Prateek Sharma, MD Guest Editor
The rise in the incidence of esophageal adenocarcinoma has been witnessed in the United States and in the entire western world. Mortality rates from this cancer have paralleled this increase in incidence. Barrett’s esophagus as a premalignant lesion is recognized in the majority of cases of adenocarcinoma of the esophagus and esophagogastric junction. Increasing attention has recently been focused on the diagnosis and treatment of Barrett’s esophagus with attempts to reverse the lesion, and alter the progression to dysplasia and adenocarcinoma. The current treatment of patients with Barrett’s esophagus is aimed at reducing esophageal acid exposure by proton pump inhibitor therapy or by antireflux surgery. Although reflux symptoms are significantly improved in patients with Barrett’s esophagus by acid-reducing therapies, their impact on neoplastic progression has yet to be demonstrated in clinical trials. Use of aspirin or other selective/nonselective cyclo-oxygenase inhibitors as an adjunct to acid reduction therapy appears to hold promise as a chemotherapeutic strategy. Use of various tools to ‘‘ablate’’ Barrett’s mucosa have consistently shown subsquamous regrowth/persistence of metaplasia and occasionally also of dysplastic/cancerous tissue. These endoscopic techniques, however, can probably play a role in subgroups of patients with high-grade dysplasia or early adenocarcinoma. Clearly we have a long way to go before cancer-reducing strategies can be applied to all patients with Barrett’s esophagus. A previous issue of the Gastrointestinal Endoscopy Clinics of North America discussed the epidemiology, endoscopic diagnosis, and alternative methods for diagnosis of intestinal metaplasia, dysplasia, and cancer. In this issue, the controversies surrounding the use of endoscopic techniques as well as medical and surgical interventions are discussed eloquently by leaders in the Barrett’s 1052-5157/03/$ – see front matter D 2003 Elsevier Inc. All rights reserved. doi:10.1016/S1052-5157(03)00045-X
xiv
P. Sharma / Gastrointest Endoscopy Clin N Am 13 (2003) xiii–xiv
arena. All of the authors have provided in-depth reviews of their topics that contain extremely useful clinical information. This should provide clinicians with a better and informed understanding about the various approaches to treatment of patients with Barrett’s esophagus and esophageal cancer. Once again, I would like to thank all the authors for their efforts and to Mary Mackison and Kerry Holland for their help with the preparation of this issue. Prateek Sharma, MD Division of Gastroenterology and Hepatology University of Kansas School of Medicine VA Medical Center Kansas City, MO 64128, USA E-mail address: [email protected]