Preventing Progression to Cancer in Barrett's Esophagus

March 5, 2015
Jeannette Y. Wick, RPh, MBA, FASCP

Since patients with Barrett's esophagus seem to progress to cancerous stages faster than others, health care professionals might perceive that controlling acid reflux would prevent the transition.

Since patients with Barrett’s esophagus (BE) seem to progress to cancerous stages faster than others, health care professionals might perceive that controlling acid reflux would prevent the transition.

Although this theory has not been definitively proven, Surgical Endoscopy published a retrospective cohort study online ahead of print that suggests it is probably correct.

A team from NorthShore University HealthSystem in Evanston, Illinois, examined a cohort of 1830 patients diagnosed with BE at the system’s hospitals and clinics. They identified various types of reflux control and also looked at progression rates to dysplasia and esophageal adenocarcinoma. They followed patients for up to 10 years, collecting data on endoscopic findings, medication use, and history of bariatric and anti-reflux surgery.

Among the study population, 102 patients progressed to low-grade dysplasia, high-grade dysplasia, or biopsy-confirmed esophageal adenocarcinoma. Overall, the annual incidence rate was 1.1%.

The group that progressed was more likely to be male and tended to be older. In fact, the authors identified age >75 years as a significant risk factor for progression.

While patients with histories of esophageal candidiasis were 5 times more likely to progress than others, those who had undergone anti-reflux surgery or used proton-pump inhibitors (PPIs) sans surgery progressed at significantly lower rates.

Patients who experienced regression—defined as a negative set of biopsies from surveillance endoscopy at any point during the follow-up period, regardless of recurrence—were considerably less likely to progress to dysplasia and esophageal adenocarcinoma. Only 1 patient in this group progressed, though 38% developed recurrent BE.

The researchers advocated for tight reflux control in non-dysplastic BE patients. They indicated that further studies are needed to determine the best reflux control, as well as which BE patients benefit most from long-term PPI therapy or anti-reflux surgery.