6 June 2019

In Nature Reviews Disease Primers Yonne Peters and Ali Al-Kaabi provided a global overview of Barrett oesophagus and outlined key open research questions. This primer covered epidemiology, disease mechanism, diagnose, screening, prevention, management, and quality of life.

In Nature Reviews Disease Primers Yonne Peters and Ali Al-Kaabi provided an up-to-date overview of Barrett oesophagus, a precursor of oesophageal adenocarcinoma. We discussed the epidemiology and pathophysiology, the criteria for the diagnosis of Barrett’s and explored developments in screening and surveillance. In addition, we reviewed the management, including endoscopic eradication strategies, and the effect of the condition on the quality of life of patients. The article gives a global perspective for the benefit of biomedical scientists, putting current clinical and translational challenges into context.

Barrett oesophagus (BE), the only known histological precursor of oesophageal adenocarcinoma (EAC), is a condition in which the squamous epithelium of the oesophagus is replaced by columnar epithelium as an adaptive response to gastro-oesophageal reflux. EAC has one of the fastest rising incidences of cancers in Western countries and has a dismal prognosis. BE is usually detected during endoscopic examination, and diagnosis is confirmed by the histological presence of intestinal metaplasia. Advances in genomics and transcriptomics have improved our understanding of the pathogenesis and malignant progression of intestinal metaplasia. As the majority of EAC cases are diagnosed in individuals without a known history of BE, screening for BE could potentially decrease disease-related mortality. Owing to the pre-malignant nature of BE, endoscopic surveillance of patients with BE is imperative for early detection and treatment of dysplasia to prevent further progression to invasive EAC. Developments in endoscopic therapy have resulted in a major shift in the treatment of patients with BE who have dysplasia or early EAC, from surgical resection to endoscopic resection and ablation. In addition to symptom control by optimization of lifestyle and pharmacological therapy with proton pump inhibitors, chemopreventive strategies based on NSAIDs and statins are currently being investigated for BE management.

Barrett oesophagus.
Peters Y, Al-Kaabi A, Shaheen NJ, Chak A, Blum A, Souza RF, Di Pietro M, Iyer PG, Pech O, Fitzgerald RC, Siersema PD.

Yonne Peters and Ali Al-Kaabi are members of theme Tumors of digestive tract.

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