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Barrett EsophagusA Review

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Abstract

Importance  Barrett esophagus is characterized by the replacement of normal esophageal squamous cell epithelium with columnar metaplasia and affects approximately 5% of people in the US and approximately 1% worldwide. Approximately 3% to 5% of patients with Barrett esophagus will be diagnosed with esophageal adenocarcinoma in their lifetime.

Observations  Barrett esophagus affects approximately 2.3% to 8.3% of people with gastroesophageal reflux disease (GERD) and approximately 1.2% to 5.6% of people without GERD. Characteristics associated with Barrett esophagus include older age (prevalence of approximately 1.1% in individuals older than 50 years compared with 0.3% in those 50 years or younger), male sex, and smoking (prevalence of approximately 12% in people who smoke cigarettes compared with 1.1% in those who do not smoke cigarettes). The histopathology of Barrett esophagus progresses from metaplasia to dysplasia and, without treatment, can progress to adenocarcinoma. People with Barrett esophagus have approximately a 0.2% to 0.5% annual rate of developing esophageal adenocarcinoma. Management of Barrett esophagus primarily consists of acid-suppressive medications to reduce underlying GERD symptoms and surveillance endoscopy every 3 to 5 years. In patients with Barrett esophagus and dysplasia or early cancer, endoscopic therapy consisting of resection and ablation successfully treats 80% to 90% of patients.

Conclusions and Relevance  Barrett esophagus affects approximately 5% of people in the US and approximately 1% worldwide and is associated with an increased risk of esophageal adenocarcinoma. First-line therapy for Barrett esophagus consists of proton-pump inhibitors for control of reflux symptoms, but their role in chemoprevention is unclear. Surveillance with upper endoscopy is recommended by practice guidelines to monitor for progression to esophageal adenocarcinoma, but randomized clinical trials are lacking.

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Article Information

Corresponding Author: Prateek Sharma, MD, University of Kansas School of Medicine, VA Medical Center, 4801 E Linwood Blvd, Kansas City, MO 64128 (psharma@kumc.edu).

Accepted for Publication: July 14, 2022.

Author Contributions: Dr Sharma had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Sharma.

Acquisition, analysis, or interpretation of data: Sharma.

Drafting of the manuscript: Sharma.

Critical revision of the manuscript for important intellectual content: Sharma.

Administrative, technical, or material support: Sharma.

Conflict of Interest Disclosures: Dr Sharma reported receiving research grants from ERBE, Ironwood Pharmaceuticals, Olympus, and Medtronic; being a consultant for Takeda, Samsung Bioepis, Olympus, and Lumendi; and receiving other funding from Medtronic, Fujifilm Medical Systems USA, and Salix.

Additional Contributions: I acknowledge David Wild, BS, and Jordanna Bermack, PhD, for assistance in guiding the search and critical review of the manuscript. Neither were compensated for this work.

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