Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, PA 17822, USA.
Int J Mol Sci. 2023 Mar 23;24(7):6018. doi: 10.3390/ijms24076018.
Esophageal adenocarcinoma (EAC) is rapidly increasing in incidence and is associated with a poor prognosis. Barrett's esophagus (BE) is a known precursor of esophageal adenocarcinoma. This review aims to explore Barrett's esophagus, esophageal adenocarcinoma, and the progression from the former to the latter. An overview of the definition, diagnosis, epidemiology, and risk factors for both entities are presented, with special attention being given to the areas of debate in the literature. The progression from Barrett's esophagus to esophageal adenocarcinoma is reviewed and the relevant molecular pathways are discussed. The definition of Barrett's esophagus remains debated and without international consensus. This, alongside other factors, has made establishing the true prevalence of Barrett's esophagus challenging. The degree of dysplasia can be a histological challenge, but is necessary to guide clinical management. The progression of BE to EAC is likely driven by inflammatory pathways, pepsin exposure, upregulation of growth factor pathways, and mitochondrial changes. Surveillance is maintained through serial endoscopic evaluation, with shorter intervals recommended for high-risk features.
食管腺癌（EAC）的发病率迅速上升，预后不良。巴雷特食管（BE）是食管腺癌的已知前体。本综述旨在探讨巴雷特食管、食管腺癌以及从前者到后者的进展。概述了这两种疾病的定义、诊断、流行病学和危险因素，特别关注文献中有争议的领域。综述了从巴雷特食管到食管腺癌的进展，并讨论了相关的分子途径。巴雷特食管的定义仍有争议，没有国际共识。这一点，以及其他因素，使得确定巴雷特食管的真实患病率具有挑战性。不典型增生的程度可能是一个组织学上的挑战，但对于指导临床管理是必要的。BE 向 EAC 的进展可能是由炎症途径、胃蛋白酶暴露、生长因子途径的上调和线粒体变化驱动的。通过定期内镜评估进行监测，对于高危特征建议缩短间隔时间。
