Young onset esophageal adenocarcinomas have poorer prognosis
Young-onset esophageal adenocarcinoma, while uncommon, is rising in incidence. Concerningly, the proportion of advanced disease continues to increase. Young-onset esophageal adenocarcinoma also presents at more advanced stages, resulting in poorer esophageal adenocarcinoma–free survival.
Predictive model for progression in Barrett's
Using a Bayesian approach, these authors combine results from multiple studies to risk stratify persons with Barrett's. They also identify potential changes in risk associated with preventive measures such as statin use and weight loss.
Copy number instability key to risk prediction in Barrett's
British study lends strong support to use of genomic risk stratification (genomoe-wide copy number instability) to enable earlier intervention for high-risk Barrett's and at the same time reduce the intensity of monitoring and even reduce overtreatment in cases of stable disease.
Utility of Cytosponge demonstrated
This impressive randomized trial observed an approximately 10-fold increase in detection of Barrett's with use of the Cytosponge non-endoscopic test. Nine persons in the Cytosponge group were found to have treatable dysplasia or early stage cancer vs. none in the usual care group.
Barrett's in children
Barrett's in children does occur, but is rare. This cases series demonstrates a very strong preponderance in males. Among a very few children followed over time, several developed low grade dysplasia, but non were observed to progress to high grade dysplasia or cancer.
Mathematical modeling of optimal screening age for Barrett's
Kit Curtius and colleagues from the U.S. and India demonstrate how mathematical modeling of cancer evolution can be used to optimize age at initial screening for Barrett's and esophageal adenocarcinoma. Their research suggests that optimal screening ages for patients with symptomatic gastroesophageal reflux are older (58 for men, 64 for women) than what is currently recommended (age > 50 years.)
Predicting presence of Barrett's
Strengths of this risk prediction model for Barrett's includes the relatively large number of cases and an external validation dataset. A limitation is that only those with symtomatic GERD (reflux) were included, so this is not necessarily generalizable to the general adult population. The authors observed that age, sex, cigarette smoking, waist circumference, frequency of stomach pain, duration of heartburn and acidic taste, and taking antireflux medication were predictive with an AUC of 0.81 in validation set.
Optimizing Barrett's management
Investigators in the CISNET Esophagus consortium employed comparative modeling to develop recommendations on clinical management (surveillance frequency and endoscopic eradication therapy) of persons with low grade or non-dysplastic Barrett's esophagus.
Early age of reflux symptoms predictive of Barrett's
This study from Kaiser Permanente Northern California oberved that early onset of reflux symptoms approximately doubles risk of Barrett's esophagus, and that both severity and frequency of reflux symptoms are important in predicting risk.
Childhood obesity and subsequent esophageal cancer risk
Dr. Petrick and colleagues reported on childhood obesity and subsequent risk of esophageal and gastric cancer in over 60,000 young Danish men. This is one of the first studies that indicate that reduction in obesity between childhood and adulthood may reduce subsequent risk.
Sleep apnea and BE
This provocative study, while based on a chart review, suggests that persons with obstructive sleep apnea have a three-fold increased risk of BE even after controlling for obesity and reflux symptoms.
Risk Calculator for Esophageal Adenocarcinoma
This paper describes the development of the IC-RISC™ calculator and provides examples of its application in the general population and among persons with Barrett’s esophagus. (See “What’s Your Risk” menu above for the actual calculator.)