Journal of Digestive Cancer Research

Korean Society of Gastrointestinal Cancer Research (대한소화기암연구학회)
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Chemoprevention of Barrett's Esophagus

바렛식도의 화학예방

  • Kyung Ho Song (Department of Internal Medicine, CHA Ilsan Medical Center)
  • 송경호 (CHA 의과학대학교 일산차병원 내과학교실)
  • Received : 2023.03.20
  • Accepted : 2023.03.24
  • Published : 2023.04.20
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Abstract

The prevalence of Barrett's esophagus is increasing in South Korea. Several strategies have been tried to prevent its progression to esophageal adenocarcinoma. It is questionable whether the strategies being tried in the West can be applied adequately in South Korea. However, despite the incidence of esophageal adenocarcinoma in the West, which is considerably higher than that in South Korea, the incidence of high-grade dysplasia/esophageal adenocarcinoma in population-based studies is as low as 0.23%/person-year. Therefore, in Korea, where the prevalence is lower than that, it is necessary to select high-risk groups more carefully for chemoprevention. The age of onset of gastroesophageal reflux disease-like symptoms at least once a week is related to the high-risk group rather than the presence or absence of chronic gastroesophageal reflux symptoms. The risk factors for esophageal adenocarcinoma include the patient's sex, age, smoking habit, and obesity. Proton pump inhibitors have a better preventive effect against esophageal adenocarcinoma compared to H2-receptor blockers, but their application to patients in Korea is limited due to the high number of individuals in need of treatment. Therefore, while considering the risk factors for the progression of esophageal adenocarcinoma, the administration of proton pump inhibitors should be considered for gastroesophageal reflux disease.

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References

  1. Devesa SS, Blot WJ, Fraumeni JF Jr. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 1998;83:2049-2053. https://doi.org/10.1002/(SICI)1097-0142(19981115)83:10<2049::AID-CNCR1>3.0.CO;2-2
  2. Yousef F, Cardwell C, Cantwell MM, Galway K, Johnston BT, Murray L. The incidence of esophageal cancer and high-grade dysplasia in Barrett's esophagus: a systematic review and meta-analysis. Am J Epidemiol 2008;168:237-249. https://doi.org/10.1093/aje/kwn121
  3. Bhat S, Coleman HG, Yousef F, et al. Risk of malignant progression in Barrett's esophagus patients: results from a large population-based study. J Natl Cancer Inst 2011;103:1049-1057. https://doi.org/10.1093/jnci/djr203 Erratum in: J Natl Cancer Inst 2013;105:581.
  4. Shaheen NJ, Falk GW, Iyer PG, et al. Diagnosis and management of Barrett's esophagus: an updated ACG guideline. Am J Gastroenterol 2022;117:559-587. https://doi.org/10.14309/ajg.0000000000001680
  5. Thrift AP, Kramer JR, Qureshi Z, Richardson PA, El-Serag HB. Age at onset of GERD symptoms predicts risk of Barrett's esophagus. Am J Gastroenterol 2013;108:915-922. https://doi.org/10.1038/ajg.2013.72
  6. Pandeya N, Webb PM, Sadeghi S, Green AC, Whiteman DC. Gastro-oesophageal reflux symptoms and the risks of oesophageal cancer: are the effects modified by smoking, NSAIDs or acid suppressants? Gut 2010;59:31-38. https://doi.org/10.1136/gut.2009.190827
  7. Rex DK, Cummings OW, Shaw M, et al. Screening for Barrett's esophagus in colonoscopy patients with and without heartburn. Gastroenterology 2003;125:1670-1677. https://doi.org/10.1053/j.gastro.2003.09.030
  8. Ward EM, Wolfsen HC, Achem SR, et al. Barrett's esophagus is common in older men and women undergoing screening colonoscopy regardless of reflux symptoms. Am J Gastroenterol 2006;101:12-17. https://doi.org/10.1111/j.1572-0241.2006.00379.x
  9. Nguyen TH, Thrift AP, Rugge M, El-Serag HB. Prevalence of Barrett's esophagus and performance of societal screening guidelines in an unreferred primary care population of U.S. veterans. Gastrointest Endosc 2021;93:409-419.e1. https://doi.org/10.1016/j.gie.2020.06.032
  10. Prasad GA, Bansal A, Sharma P, Wang KK. Predictors of progression in Barrett's esophagus: current knowledge and future directions. Am J Gastroenterol 2010;105:1490-1502. https://doi.org/10.1038/ajg.2010.2
  11. Krishnamoorthi R, Singh S, Ragunathan K, et al. Factors associated with progression of Barrett's esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2018;16:1046-1055.e8. https://doi.org/10.1016/j.cgh.2017.11.044
  12. Moe GL, Kristal AR, Levine DS, Vaughan TL, Reid BJ. Waist-to-hip ratio, weight gain, and dietary and serum selenium are associated with DNA content flow cytometry in Barrett's esophagus. Nutr Cancer 2000;36:7-13. https://doi.org/10.1207/S15327914NC3601_2
  13. Gammon MD, Schoenberg JB, Ahsan H, et al. Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 1997;89:1277-1284. https://doi.org/10.1093/jnci/89.17.1277
  14. Weston AP, Badr AS, Hassanein RS. Prospective multivariate analysis of factors predictive of complete regression of Barrett's esophagus. Am J Gastroenterol 1999;94:3420-3426. https://doi.org/10.1111/j.1572-0241.1999.01603.x
  15. Weston AP, Sharma P, Mathur S, et al. Risk stratification of Barrett's esophagus: updated prospective multivariate analysis. Am J Gastroenterol 2004;99:1657-1666. https://doi.org/10.1111/j.1572-0241.2004.30426.x
  16. O'Connor JB, Falk GW, Richter JE. The incidence of adenocarcinoma and dysplasia in Barrett's esophagus: report on the Cleveland Clinic Barrett's Esophagus Registry. Am J Gastroenterol 1999;94:2037-2042. https://doi.org/10.1111/j.1572-0241.1999.01275.x
  17. Rudolph RE, Vaughan TL, Storer BE, et al. Effect of segment length on risk for neoplastic progression in patients with Barrett esophagus. Ann Intern Med 2000;132:612-620. https://doi.org/10.7326/0003-4819-132-8-200004180-00003
  18. Wani S, Falk G, Hall M, et al. Patients with nondysplastic Barrett's esophagus have low risks for developing dysplasia or esophageal adenocarcinoma. Clin Gastroenterol Hepatol 2011;9:220-227; quiz e26. https://doi.org/10.1016/j.cgh.2010.11.008
  19. Avidan B, Sonnenberg A, Schnell TG, Chejfec G, Metz A, Sontag SJ. Hiatal hernia size, Barrett's length, and severity of acid reflux are all risk factors for esophageal adenocarcinoma. Am J Gastroenterol 2002;97:1930-1936. https://doi.org/10.1111/j.1572-0241.2002.05902.x
  20. Gaddam S, Singh M, Balasubramanian G, et al. Persistence of nondysplastic Barrett's esophagus identifies patients at lower risk for esophageal adenocarcinoma: results from a large multicenter cohort. Gastroenterology 2013;145:548-553.e1. https://doi.org/10.1053/j.gastro.2013.05.040
  21. Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999;340:825-831. https://doi.org/10.1056/NEJM199903183401101
  22. Cook MB, Corley DA, Murray LJ, et al. Gastroesophageal reflux in relation to adenocarcinomas of the esophagus: a pooled analysis from the Barrett's and Esophageal Adenocarcinoma Consortium (BEACON). PLoS One 2014;9:e103508. https://doi.org/10.1371/journal.pone.0103508
  23. Singh S, Garg SK, Singh PP, Iyer PG, El-Serag HB. Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett's oesophagus: a systematic review and meta-analysis. Gut 2014;63:1229-1237. https://doi.org/10.1136/gutjnl-2013-305997
  24. Kastelein F, Spaander MC, Steyerberg EW, et al. Proton pump inhibitors reduce the risk of neoplastic progression in patients with Barrett's esophagus. Clin Gastroenterol Hepatol 2013;11:382-388. https://doi.org/10.1016/j.cgh.2012.11.014
  25. Hu Q, Sun TT, Hong J, Fang JY, Xiong H, Meltzer SJ. Proton pump inhibitors do not reduce the risk of esophageal adenocarcinoma in patients with Barrett's esophagus: a systematic review and meta-analysis. PLoS One 2017;12:e0169691. https://doi.org/10.1371/journal.pone.0169691
  26. Spechler SJ, Sharma P, Traxler B, Levine D, Falk GW. Gastric and esophageal pH in patients with Barrett's esophagus treated with three esomeprazole dosages: a randomized, double-blind, crossover trial. Am J Gastroenterol 2006;101:1964-1971. https://doi.org/10.1111/j.1572-0241.2006.00661.x
  27. Wani S, Sampliner RE, Weston AP, et al. Lack of predictors of normalization of oesophageal acid exposure in Barrett's oesophagus. Aliment Pharmacol Ther 2005;22:627-633. https://doi.org/10.1111/j.1365-2036.2005.02626.x
  28. Jo HJ, Lee HS, Kim N, et al. Predictable marker for regression of Barrett's esophagus by proton pump inhibitor treatment in Korea. J Neurogastroenterol Motil 2013;19:210-218. https://doi.org/10.5056/jnm.2013.19.2.210
  29. Chang EY, Morris CD, Seltman AK, et al. The effect of antireflux surgery on esophageal carcinogenesis in patients with barrett esophagus: a systematic review. Ann Surg 2007;246:11-21. https://doi.org/10.1097/01.sla.0000261459.10565.e9