Barrett's Esophagus: Emerging Knowledge and Management Strategies.
Barrett's Esophagus: Emerging Knowledge and Management Strategies.
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DOI：
10.1155/2012/814146
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Mani H
中科院分区：
文献类型：
--
作者：
Bhardwaj A;McGarrity TJ;Stairs DB;Mani H
在过去的30年里，食管腺癌（EAC）的发病率呈指数增长。Barrett食管（BE）是EAC唯一已知的前体。BE患者患EAC的风险比一般人群高40倍以上。近年来，BE的临床和分子生物学研究发生了革命性的变化。然而，这种情况的几个方面仍然存在争议。关于BE真实患病率的数据差异很大。最近的研究表明，非异型增生BE（NDBE）中EAC的发生率低于以前的报道。缺乏显示BE筛查或监测的生存获益的前瞻性数据。此外，越来越多的强调医疗成本控制要求重新审查的筛选和监测战略BE。有必要确定可靠的临床预测因子或分子生物标志物，对可能从BE筛查或监测中获益最多的患者进行风险分层。最后，出现了用于管理发育不良BE的新疗法。在本文中，我们强调了围绕BE的争议和不确定性的关键领域。本文详细讨论了BE的分子发病机制、生物标志物、组织病理学诊断和治疗策略的最新文献。
The incidence of esophageal adenocarcinoma (EAC) has increased exponentially in the last 3 decades. Barrett's esophagus (BE) is the only known precursor of EAC. Patients with BE have a greater than 40 folds higher risk of EAC compared with the general population. Recent years have witnessed a revolution in the clinical and molecular research related to BE. However, several aspects of this condition remain controversial. Data regarding the true prevalence of BE have varied widely. Recent studies have suggested a lower incidence of EAC in nondysplastic BE (NDBE) than previously reported. There is paucity of prospective data showing a survival benefit of screening or surveillance for BE. Furthermore, the ever-increasing emphasis on healthcare cost containment has called for reexamination of the screening and surveillance strategies for BE. There is a need for identification of reliable clinical predictors or molecular biomarkers to risk-stratify patients who might benefit the most from screening or surveillance for BE. Finally, new therapies have emerged for the management of dysplastic BE. In this paper, we highlight the key areas of controversy and uncertainty surrounding BE. The paper discusses, in detail, the current literature about the molecular pathogenesis, biomarkers, histopathological diagnosis, and management strategies for BE.