Dutch study on RFA/EMR effectiveness
In an observational study of 1154 patients with BE or early EAC, 94% achieved complete eradication after treatment with RFA/EMR. A dysplasia recurrence rate of 1% per year was observed over a median 43 months.
Young onset esophageal adenocarcinomas have poorer prognosis
Young-onset esophageal adenocarcinoma, while uncommon, is rising in incidence. Concerningly, the proportion of advanced disease continues to increase. Young-onset esophageal adenocarcinoma also presents at more advanced stages, resulting in poorer esophageal adenocarcinoma–free survival.
Predictive model for progression in Barrett's
Using a Bayesian approach, these authors combine results from multiple studies to risk stratify persons with Barrett's. They also identify potential changes in risk associated with preventive measures such as statin use and weight loss.
Copy number instability key to risk prediction in Barrett's
British study lends strong support to use of genomic risk stratification (genomoe-wide copy number instability) to enable earlier intervention for high-risk Barrett's and at the same time reduce the intensity of monitoring and even reduce overtreatment in cases of stable disease.
Utility of Cytosponge demonstrated
This impressive randomized trial observed an approximately 10-fold increase in detection of Barrett's with use of the Cytosponge non-endoscopic test. Nine persons in the Cytosponge group were found to have treatable dysplasia or early stage cancer vs. none in the usual care group.
Barrett's in children
Barrett's in children does occur, but is rare. This cases series demonstrates a very strong preponderance in males. Among a very few children followed over time, several developed low grade dysplasia, but non were observed to progress to high grade dysplasia or cancer.
Obesity related markers and risk of Barrett's and EA
This article summarizes published reports on circulating biomarkers and risk of BE/EAC, finding that higher circulating levels of leptin, glucose, insulin, CRP, IL6, and sTNFR-2 may be associated with an increased risk of esophageal adenocarcinoma or Barrett esophagus.
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.
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.
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.