Snider Erik J, Kaz Andrew M, Inadomi John M, Grady William M
Division of Gastroenterology, Department of Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Gastroenterology Section, VA Puget Sound Health Care System, Seattle, WA, USA.
Gastroenterol Rep (Oxf). 2020 Jul 24;8(4):253-260. doi: 10.1093/gastro/goaa040. eCollection 2020 Aug.
Esophageal adenocarcinoma (EAC) is a major cause of cancer-related death, particularly in Western populations, and is rapidly rising in Asian populations at this time. Virtually all EACs develop from the precursor lesion Barrett's esophagus (BE), which is the most significant risk factor for EAC. However, the rates of progression from BE to EAC are low and patients with BE are asymptomatic. Thus, any strategy for EAC prevention must carry a low risk of harm in order to be clinically useful. Since current EAC-screening and BE-surveillance methods carry some procedural risk and are burdensome, there is an opportunity for chemoprevention, i.e. medications or dietary factors that may prevent BE from progressing to EAC. A variety of candidate chemoprevention therapies have been assessed to date. Proton-pump inhibitors (PPIs) are the best studied and have modest EAC-chemoprevention efficacy in BE patients, with a recent randomized trial showing that high-dose PPI may be more effective than low-dose PPI. Aspirin and other non-steroidal anti-inflammatory drugs have moderate quality observational and randomized-trial evidence for preventing progression of BE to EAC, but their risks for harm have precluded their routine clinical use. Other therapies (statins, metformin, female sex hormones) generally do not have strong evidence to support their use in EAC chemoprevention. Although progress has been made in this field, there is still a need for more effective and safe chemoprevention therapies for EAC.
食管腺癌（EAC）是癌症相关死亡的主要原因，尤其在西方人群中，目前在亚洲人群中的发病率也在迅速上升。几乎所有的食管腺癌都由前驱病变巴雷特食管（BE）发展而来，巴雷特食管是食管腺癌最重要的危险因素。然而，从巴雷特食管进展为食管腺癌的发生率较低，且巴雷特食管患者没有症状。因此，任何预防食管腺癌的策略在临床上要有用，就必须具有低伤害风险。由于目前的食管腺癌筛查和巴雷特食管监测方法存在一些操作风险且负担较重，因此存在化学预防的机会，即使用可能预防巴雷特食管进展为食管腺癌的药物或饮食因素。迄今为止，已经评估了多种候选化学预防疗法。质子泵抑制剂（PPI）是研究最多的，对巴雷特食管患者有一定的食管腺癌化学预防效果，最近一项随机试验表明高剂量质子泵抑制剂可能比低剂量更有效。阿司匹林和其他非甾体抗炎药有中等质量的观察性和随机试验证据支持其预防巴雷特食管进展为食管腺癌，但它们的伤害风险使其无法常规用于临床。其他疗法（他汀类药物、二甲双胍、女性性激素）通常没有强有力的证据支持其用于食管腺癌化学预防。尽管该领域已取得进展，但仍需要更有效、更安全的食管腺癌化学预防疗法。
