Incidence and Risk Factors of Neoplastic Progression in Barrett’s Esophagus

Barrett’s esophagus (BE) is a condition in which the normal stratified squamous epithelium lining the distal esophagus is replaced by columnar epithelium with specialized intestinal metaplasia (IM) containing goblet cells. The development of BE is a complication of chronic exposure to the gastric refluxate containing acid and bile.1-3 BE is a premalignant condition which predisposes to the development of esophageal adenocarcinoma (EAC). The development of this malignancy is a gradual stepwise process from no dysplasia (ND) to low-grade dysplasia (LGD), high-grade dysplasia (HGD), and finally EAC. During the past decades, the incidence of both BE5 and EAC has been rising rapidly as demonstrated by a 7-fold increased incidence of EAC between 1973 and 2006.6-8 In general, patients with BE have a 30- to 125-fold increased risk of developing EAC compared to the general population. However, the annual incidence of EAC in BE patients remains unclear, as it shows considerable variation among cohort studies, ranging from 0.2% to almost 3.5% per year. The consensus is however that the incidence of EAC is approximately 0.5% per year.13 EAC usually has a poor prognosis and a high mortality with a 5-year survival rate of less than 20%. As a result of the malignant potential of BE, regular surveillance endoscopies are recommended in patients with BE. The intervals of surveillance depend on the grade of dysplasia present. The goal of surveillance is to detect neoplasia at an early stage, making early treatment with curative intention possible and reducing death from EAC.

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