Since approximately 40% of esophageal adenocarcinoma cases arise in persons without significant gastroesophageal reflux (Nat Rev Cancer 2015), it has long been clear that screening guidelines that require GERD symptoms will miss a significant proportion of prevalent cases. Current guidelines are also inefficient with low specificity (Clin Gastroenterol Hepatol 2019.
This thoughtful and thorough analysis of food frequency dietary data from the Melbourne Cohort Study supports previous research indicating that regular intake of leafy vegetables and fruit may independently decrease risk of Barrett's esophagus, in this instance by approximately 40%. Br J Nutr. 2022 Jul 15;1-28. doi:
Given that the incidence of esophageal adenocarcinoma in the U.S. varies dramatically by sex and race, it seems likely that optimal screening programs might vary as well. CISNET investigators used comparative cost-effectiveness analysis to identify optimal ages for screening by sex and race. Among white men, they found that
Important guideline updates include the recommendations for nonendoscopic screening methods, longer intervals for short-segment BE surveillance, and specific suggestions for post-ablation surveillance. Am J Gastroenterol. 2022 Apr 1;117(4):559-587. doi: 10.14309/ajg.0000000000001680. Diagnosis and Management of Barrett's Esophagus: An Updated ACG Guideline Nicholas J
The authors calculated temporal trends in esophageal adenocarcinoma from 1989-2016 in the Netherlands, finding substantial increases. They projected rates about 30% higher in the late 2030's. Int J Cancer. 2022 Feb 1;150(3):420-430. doi: 10.1002/ijc.33836. Epub 2021 Oct 16. Trends and projections in
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A large multi-center study across three countries in east Africa confirms the significant role that alcohol intake plays in the public health burden of esophageal squamous cell carcinoma in these countries, particularly among men. Lancet Glob Health. 2022 Feb;10(2):e236-e245. doi: 10.1016/S2214-109X(21)00506-4. Epub 2021
Using the VA Central Cancer Registry, the authors investigated opportunites to undergo screening for esophageal adenocarcinoma (EAC), finding more than 80% of cancer patients had not undergone prior upper endoscopy, even though the vast majority had potential opportunities. Gastroenterology. 2021 Dec 20;S0016-5085(21)04091-9. doi: 10.1053/j.gastro.
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Dr. Matt Buas and colleagues analyzed clinical and lifestyle factors among 371 persons with esophageal adenocarcinoma. A number of factors correlated with improved survival, depending on stage. Among those with localized or regional tumors, smoking was associated with a 2.5-fold increased mortality. Cancers (Basel). 2021 Sep 16;13(18)
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Proton pump inhibitors (PPIs) are commonly used to treat reflux, a key risk factor for esophageal adenocarcinoma. However, they have the potential for side effects. This expert review provides "best practice advice" for de-prescribing PPIs. Gastroenterology. 2022 Feb 16;S0016-5085(21)04083-X. doi:10.1053/j.gastro.2021.
In addition to serving as a minimally invasive screening tool to help identify persons with Barrett's (BE), dysplasia and early stage esophageal adenocarcinoma, the Cytosponge (and similar devices) also have a potentially important role in long term surveillance of persons with BE. Lancet Oncol. 2022 Feb;23(2)
Results from a study from a high-risk area in China indicate that esopphageal cells captured non-invasively via a capsule sponge, when combined with a trained artificial intelligence (AI) system can substantially reduce the need for endoscopy with histopathology, with a sensitivity of 93.7%.
This nice review updates the molecular/genomic changes leading to esophageal adenocarcinoma and makes the link to more effective screening and treatment approaches.