Published online Nov 21, 2017. doi: 10.3748/wjg.v23.i43.7653
Peer-review started: August 23, 2017
First decision: September 28, 2017
Revised: October 18, 2017
Accepted: October 26, 2017
Article in press: October 26, 2017
Published online: November 21, 2017
Processing time: 89 Days and 20.4 Hours
The histological commitment of the lower oesophageal mucosa largely depends on a complex molecular landscape. After extended inflammatory insult due to gastroesophageal reflux disease, squamous oesophageal mucosa may differentiate into columnar metaplastic mucosa. In this setting, the presence of intestinal metaplasia is considered the starting point of Barrett’s carcinogenetic cascade. Aside from secondary prevention strategies for Barrett’s mucosa (BM) patients, there are multiple endoscopic ablative therapies available for BM eradication and for the replacement of metaplastic epithelia with a neosquamous mucosa. However, BM frequently recurs in a few years, which supports the notable phenotypic plasticity of the oesophageal mucosa. In recent years, several reports pinpointed a class of small noncoding RNAs, the microRNAs (miRNAs), as principal effectors and regulators of oesophageal mucosa metaplastic (and neoplastic) transformation. Because of miRNAs notable stability in fixed archival diagnostic specimens, expression profiling of miRNAs represent an innovative diagnostic, prognostic and predictive tool in the stratification of phenotypic alterations in the oesophageal mucosa.
Core tip: Recent advances in understanding the molecular role of noncoding RNAs in Barrett's carcinogenesis have significantly contributed to the identification of novel and alternative molecular pathways involved in this carcinogenetic setting. In the future, these data may significantly influence the planning of secondary prevention strategies for Barrett’s mucosa patients and help to select new therapies.