Recent findings

Cost-effectiveness analysis of EET

Cost-effectiveness modeling from UK indicates that endoscopic eradiction therapy for both low and high-grade dysplasia is cost-effective compared to surveillance.

SURF study long term results

Long term outcomes from SURF clinical trial of RFA for low grade dysplasia confirms strong benefit in risk of HGD or esophageal adenocarcinoma.

RIBBON Network confirms progression risk in Barrett's

Ireland consortium estimates progression from Barrett's to esophageal adenocarcinoma or high grade dysplasia, finding risks similar to previous studies, but higher risk among confirmed low grade dysplasias.

Updated ASGE Guidelines for screening and surveillance of Barrett's

In this publication, the American Society for Gastrointestinal Endoscopy updated their guidelines for screening/surveillance of BE.

Nissen-Sleeve may reduce GERD after bariatric surgery

French investigators observed that modification of a standard bariatric surgery technique resulted in low prevalence of post-surgery GERD symptoms.

Mathematical modeling of optimal screening age for Barrett's

Kit Curtius and colleagues from the U.S. and India demonstrate how mathematical modeling of cancer evolution can be used to optimize age at initial screening for Barrett's and esophageal adenocarcinoma. Their research suggests that optimal screening ages for patients with symptomatic gastroesophageal reflux are older (58 for men, 64 for women) than what is currently recommended (age > 50 years.)

EAC incidence continues to rise in Switzerland

EAC became the most common form of esophageal cancer in Switzerland around 2010. From the authors' conclusions:A significant increase in the incidence of adenocarcinoma of the oesophagus was observed in Switzerland during thestudy period 1986-2015. A parallel rise of GORD and obesity over the same period may, at least partially, be responsible for this trend. For oesophageal squamous cell carcinoma, a decreasing trend was only observed in males most likely related to sex-specific lifestyle changes.

Inherited susceptibility to GERD

Over 350,000 records were analyzed to identify genetic markers (SNPs) and genes related to the prevalence of GERD (gastroesophageal reflux.) 25 new loci were identified, most of which also associated with increased risk of Barrett's and/or esophageal adenocarcinoma. Three of the target genes are already GERD/EA/BE drug targets and four others are drug targets for other diseases and as such would be very interesting to investigate for potential medication repurposing for reflux, BE, or EA.

Predicting presence of Barrett's

Strengths of this risk prediction model for Barrett's includes the relatively large number of cases and an external validation dataset. A limitation is that only those with symtomatic GERD (reflux) were included, so this is not necessarily generalizable to the general adult population. The authors observed that age, sex, cigarette smoking, waist circumference, frequency of stomach pain, duration of heartburn and acidic taste, and taking antireflux medication were predictive with an AUC of 0.81 in validation set.

What happens after ablation for Barrett's?

This review paper summarizes some of the current issues in surveillance and treatment after endoscopic eradication therapy (e.g., RFA) for Barrett's dysplasia.

Optimizing Barrett's management

Investigators in the CISNET Esophagus consortium employed comparative modeling to develop recommendations on clinical management (surveillance frequency and endoscopic eradication therapy) of persons with low grade or non-dysplastic Barrett's esophagus.

Among those with Barrett's, who is more likely to progress?

While not breaking any new ground, this large meta-analysis observed that older age, male sex, smoking, longer BE segment, and LGD were predictive of progression of BE to dysplasia or cancer.

Early age of reflux symptoms predictive of Barrett's

This study from Kaiser Permanente Northern California oberved that early onset of reflux symptoms approximately doubles risk of Barrett's esophagus, and that both severity and frequency of reflux symptoms are important in predicting risk.

Childhood obesity and subsequent esophageal cancer risk

Dr. Petrick and colleagues reported on childhood obesity and subsequent risk of esophageal and gastric cancer in over 60,000 young Danish men. This is one of the first studies that indicate that reduction in obesity between childhood and adulthood may reduce subsequent risk.

Comparison of epidemiology of esophageal adenocarcinoma vs. squamous vs. gastric cancers

This review summarizes the current recommendations for screening populations at high risk of developing esophagogastric cancers.

Commentary on non-invasive screening techniques

Dr. Hill and colleagues from the QIMR Berghofer in Queensland, AU, take a close look at non-invasive methods for collecting cells from the esophageal lining, and the role of blood-based biomarkers in risk stratification.

Sleep apnea and BE

This provocative study, while based on a chart review, suggests that persons with obstructive sleep apnea have a three-fold increased risk of BE even after controlling for obesity and reflux symptoms.

Risk Calculator for Esophageal Adenocarcinoma

This paper describes the development of the IC-RISC™ calculator and provides examples of its application in the general population and among persons with Barrett’s esophagus. (See “What’s Your Risk” menu above for the actual calculator.)

Weight loss surgery and BE

This study is one of the first to suggest that, among patients with severe obesity, weight loss surgery might induce histologic regression of BE to normal lining.

Review paper on prevalence of BE by risk factors

Some useful confirmatory data on the prevalence of BE according to status of various risk factors.

Commentary on use of PPIs and aspirin to prevent EAC

A thoughtful commentary on the strengths and weakness of the recent clinical trial of PPI and aspirin.

Tobacco use and BE

In this cross-sectional study of patients seen at Mayo Clinic between 2002 and 2010, use of smokeless tobacco and cigars or pipes was found to be associated with risk of Barrett’s in persons with GERD. Confirmatory studies are needed.

Biomarkers of inflammation in serum and risk of esophageal adenocarcinoma

Dr. Cook and colleagues at NCI report that certain markers of inflammation in blood are associated with esophageal adenocarcinoma, and conclude that systemic inflammation may underlie some of the increased risk with obesity and cigarette smoking.

Trends in Esophageal Cancer Incidence in England

Investigators from Queen Mary University of London examine past trends in esophageal cancer incidence and project a leveling off in rates of esophageal adenocarcinoma over the next two decades in England.
About
This website contains a curated and opinionated look at recent literature regarding the epidemiology and prevention of esophageal cancer, with an emphasis on esophageal adenocarcinoma. It is developed by Thomas L Vaughan MD, MPH, who can be reached with questions or suggestions through email or his research website.
©2021 Thomas L Vaughan
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This website should not be considered, or used as a substitute for, medical advice, diagnosis or treatment. This site does not constitute the practice of any medical or other professional health care advice, diagnosis or treatment. The information on this website represent the views solely of Dr. Vaughan.
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