Bhardwaj Atul, McGarrity Thomas J, Stairs Douglas B, Mani Haresh
Division of Gastroenterology and Hepatology, Penn State Milton S. Hershey Medical Center, 500 University Drive, P.O. Box 850, HU33, Hershey, PA 17033, USA.
Patholog Res Int. 2012;2012:814146. doi: 10.1155/2012/814146. Epub 2012 May 30.
The incidence of esophageal adenocarcinoma (EAC) has increased exponentially in the last 3 decades. Barrett's esophagus (BE) is the only known precursor of EAC. Patients with BE have a greater than 40 folds higher risk of EAC compared with the general population. Recent years have witnessed a revolution in the clinical and molecular research related to BE. However, several aspects of this condition remain controversial. Data regarding the true prevalence of BE have varied widely. Recent studies have suggested a lower incidence of EAC in nondysplastic BE (NDBE) than previously reported. There is paucity of prospective data showing a survival benefit of screening or surveillance for BE. Furthermore, the ever-increasing emphasis on healthcare cost containment has called for reexamination of the screening and surveillance strategies for BE. There is a need for identification of reliable clinical predictors or molecular biomarkers to risk-stratify patients who might benefit the most from screening or surveillance for BE. Finally, new therapies have emerged for the management of dysplastic BE. In this paper, we highlight the key areas of controversy and uncertainty surrounding BE. The paper discusses, in detail, the current literature about the molecular pathogenesis, biomarkers, histopathological diagnosis, and management strategies for BE.
在过去30年中，食管腺癌（EAC）的发病率呈指数级增长。巴雷特食管（BE）是已知的EAC唯一前驱病变。与普通人群相比，BE患者发生EAC的风险高出40多倍。近年来，BE相关的临床和分子研究发生了变革。然而，这种疾病的几个方面仍存在争议。关于BE真实患病率的数据差异很大。最近的研究表明，非发育异常性BE（NDBE）中EAC的发病率低于先前报道。缺乏前瞻性数据表明BE筛查或监测对生存有益。此外，对控制医疗成本的日益重视促使人们重新审视BE的筛查和监测策略。需要识别可靠的临床预测指标或分子生物标志物，以便对可能从BE筛查或监测中获益最大的患者进行风险分层。最后，针对发育异常性BE的治疗出现了新方法。在本文中，我们重点介绍了围绕BE的争议和不确定性的关键领域。本文详细讨论了有关BE分子发病机制、生物标志物、组织病理学诊断和管理策略的当前文献。
