Managing to Avoid Esophageal Cancer

Barrett esophagus management guidelines discussed

(RxWiki News) If you’ve ever had heartburn, you know it can be very uncomfortable. Ongoing heartburn, a symptom of acid reflux, can progress to a condition called Barrett esophagus, which can eventually lead to cancer. A recent literature review analyzed the best way to manage Barrett esophagus to avoid cancer.

Patients with Barrett esophagus, without abnormal cell changes called dysplasia, should receive an internal exam using a tool called an endoscope every three to five years, the review suggested.

Therapy to remove abnormal cells is the treatment of choice for patients with Barrett esophagus with aggressive (high-grade) dysplasia and may also be used for patients with low-grade dysplasia.

"Don't ignore persistent heartburn."

Stuart Jon Spechler, MD, chief of gastroenterology at VA North Texas Healthcare System in Dallas, Texas and professor of medicine at The University of Texas Southwestern Medical Center, conducted this review.

Heartburn is a symptom of gastroesophageal reflux disease (GERD), a condition in which acid flows up from the stomach into the esophagus, the tube that connects the throat with the stomach.

Barrett esophagus is a complication of GERD, which develops when cells in the esophagus start to change.

Risk factors for Barrett esophagus include having chronic (ongoing) GERD, hiatal hernia (stomach protrudes upward), being a white man over the age of 50, smoking and obesity, particularly with excessive abdominal fat.

The rate of esophageal cancer, which can be the end result of Barrett esophagus, has increased more than seven-fold in the past several decades, and there continues to be controversy about the best way to manage Barrett esophagus and treat GERD.

The aim of this study was to review current concepts regarding how Barrett esophagus develops, its diagnosis, treatment and management guidelines.

The review also aimed to discuss the importance of abnormal cell growth and the role of endoscopic eradiation therapy — the removal of abnormal cells — in managing Barrett esophagus.

Dr. Spechler conducted a literature review of studies performed between 1984 and April 2013.

“Endoscopic surveillance for dysplasia in Barrett esophagus is a widely practiced but unproven cancer prevention strategy,” Dr. Spechler wrote.

Various medical societies, such as the American College of Gastroenterology and American College of Physicians, have different guidelines on how often endoscopic studies should be performed on patients with varied grades of Barrett esophagus.

The review concluded that endoscopic screening is recommended for patients with Barrett esophagus who have other cancer risk factors such as smoking and obesity.

Patients with Barrett esophagus with no dysplasia (abnormal cell growth) can be screened every three to five years.

Endoscopic eradiation therapy, in which the abnormal cells are removed using an endoscope, is recommended for patients with high-grade (aggressive) dysplasia and is an option for patients with low-grade dysplasia.

This therapy is not recommended for the general population or for patients with Barrett esophagus with no dysplasia.

“The paper underscores the conflict between evidence and clinical practice in determining frequency of surveillance endoscopy and timing of endoscopic intervention,” Alok Khorana, MD, the Sondra and Stephen Hardis chair in oncology and incoming director of the Gastrointestinal Malignancies Program at Taussig Cancer Institute at Cleveland Clinic, told dailyRx News.

This clinical review was published August 14 in JAMA (The Journal of the American Medical Association).

Dr. Spechler reported consulting for Torax Medical, Ironwood Pharmaceuticals and Takeda, and research support from BARRX Medical.

Review Date: 
August 22, 2013