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Risk for Cancer in Patients with Barrett Esophagus
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What is the problem and what is known about it so far?
Barrett esophagus is a condition in which the lining of the esophagus (the tube that connects the mouth to the stomach) becomes abnormal. This change may occur when stomach contents, including acid, rise up into the esophagus, a condition known as gastroesophageal reflux disease (GERD). The only way to know if a person has Barrett changes is to look at the esophagus with a special instrument that is passed through the mouth into the esophagus and stomach (a procedure called esophagogastroduodenoscopy, or EGD). Using this instrument, the doctor can also take samples of the esophageal lining to examine under a microscope. Most people who have GERD never develop Barrett esophagus, but those who do are at a higher risk for esophageal cancer. Many experts therefore recommend that people with Barrett esophagus get EGDs regularly to catch cancer in an early, more treatable stage. It has been thought that the greater the length of the esophagus that shows Barrett changes, the greater the chances of developing esophageal cancer, but this has never been shown for certain.
Why did the researchers do this particular study?
To see if the length of the esophagus affected by Barrett esophagus is related to a person's risk of developing cancer.
Who was studied?
The researchers studied 309 patients with Barrett esophagus at a teaching hospital in Seattle, Washington.
How was the study done?
The patients had an EGD at regular intervals. Barrett segment length was recorded at the time of the first EGD. The researchers looked for evidence of cancer on follow-up EGDs, and in 171 patients they also looked for abnormalities of esophageal lining cells thought to be precancerous. These precancerous abnormalities are known as aneuploidy.
What did the researchers find?
Patients with short Barrett segments were not found to have a lower risk for esophageal cancer than patients with long Barrett segments. However, patients with short Barrett segments were somewhat less likely to develop precancerous abnormalities than those with long Barrett segments.
What were the limitations of the study?
The researchers followed patients for an average of only about 4 years; the findings might have been different had they followed them longer. All participants received counseling on how to reduce GERD, and most used acid-lowering medicines regularly. The findings might be different in patients who received less intense treatment for GERD.
What are the implications of the study?
The risk for cancer in patients with short Barrett segments was not substantially lower than that in patients with longer segments. Until further information is available, doctors and patients should not consider Barrett segment length when making decisions about how often to check for cancer with EGD.
Article and Author Information
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The summary below is from the full report titled “Effect of Segment Length on Risk for Neoplastic Progression in Patients with Barrett Esophagus.”. It is in the 18 April 2000 issue of Annals of Internal Medicine (volume 132, pages 612-620). The authors are R.E. Rudolph, T.L. Vaughan, B.E. Storer, R.C. Haggitt, P.S. Rabinovitch, D.S. Levine, and B.J. Reid.
- Copyright ©2004 by the American College of Physicians
