Gastroesophageal reflux, in addition to causing discomfort, such as a burning or burning sensation in the sternum or throat area, reflux of food material into the mouth, pain in the upper abdomen, precordial pain -similar to angina pectoris-, lack of appetite or feeling of fullness after eating small amounts of food, is also linked to the so-called Barrett’s esophagus. Because of this, all gastroesophageal reflux, whether acidic or weakly acidic, must be well controlled by endoscopy and correctly diagnosed and treated with diet, anti-reflux intervention or medication, in order to reduce the risk of evolution towards Barrett’s esophagus, and subsequently to adenocarcinoma.
It is essential to be clear about the concept that reflux must be well treated and diagnosed by a specialist. Proton pump inhibitors are of little use in alkaline reflux, with bile or weakly acidic material, since they contribute to its alkalinization. For this reason, esophageal pHmdetry with detection of acid and alkaline reflux should be mandatory.
Thus, the American College of Gastroenterology (ACG) has reached a number of conclusions in this regard.
Barrett’s esophagus: the study
In patients with Barrett’s esophagus, low-grade dysplasia carries a considerable risk for the progression of esophageal adenocarcinoma, with the risk of progression in these patients being eight times higher than in patients diagnosed without dysplasia.
And the fact is that, in the words of Dr. Krishnamoorthi, of the ACG, “subjects with Barrett’s esophagus diagnosed with low-grade dysplasia may be candidates for endoscopic therapy. Endoscopic ablation is a recommended strategy for such patients,” he said.
Thus, we assessed whether a diagnosis of low-grade dysplasia is associated with the risk of progression. To this end, a retrospective study was used to review data from nearly 2,000 (1998) patients with Barrett’s long segment in their esophagus and nearly 1,000 (952) with esophageal adenocarcinoma.
Gastrointestinal pathologists reviewed demographic data, histologic data, endoscopic findings, and index biopsy specimens for low-grade dysplasia. Once a diagnosis was reached, patients were grouped into five distinct groups: low-grade dysplasia, high-grade dysplasia, adenocarcinoma, undefined dysplasia or no Barrett’s esophagus dysplasia. Thus, the final sample included 249 patients with an index diagnosis of low-grade dysplasia, including 201 men and 48 women, with a mean age of 64.3 years.
Patients whose disease progressed from low-grade dysplasia to high-grade dysplasia or adenocarcinoma were then identified.
Barrett’s esophagus: progression from low-grade dysplasia to adenocarcinoma
During a median follow-up of almost eight years, fifteen patients progressed to high-grade dysplasia or adenocarcinoma. The time to progression was shorter in the confirmed low-grade dysplasia group and the indefinite dysplasia group than in the no-dysplasia group, once adjusted for age, smoking, sex, Barrett’s segment length, and other disease characteristics.