Patti MG, Waxman I. Gastroesophageal reflux disease: From heartburn to cancer. World J Gastroenterol 2010; 16(30): 3743-3744 [PMID: 20698034 DOI: 10.3748/wjg.v16.i30.3743]
Corresponding Author of This Article
Marco G Patti, MD, Professor, Director, Department of Surgery, University of Chicago Pritzker School of Medicine, 5841 S. Maryland Ave, MC 5095, Room G-201, Chicago, IL 60637, United States. mpatti@surgery.bsd.uchicago.edu
Article-Type of This Article
Editorial
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Marco G Patti, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
Irving Waxman, Center for Endoscopic Research and Therapeutics (CERT), University of Chicago Pritzker School of Medicine, Chicago, IL 60637, United States
ORCID number: $[AuthorORCIDs]
Author contributions: Patti MG wrote the manuscript; Waxman I reviewed the manuscript.
Correspondence to: Marco G Patti, MD, Professor, Director, Department of Surgery, University of Chicago Pritzker School of Medicine, 5841 S. Maryland Ave, MC 5095, Room G-201, Chicago, IL 60637, United States. mpatti@surgery.bsd.uchicago.edu
Telephone: +1-773-7024763 Fax: +1-773-7026120
Received: April 24, 2010 Revised: June 7, 2010 Accepted: June 14, 2010 Published online: August 14, 2010
Abstract
About 10%-15% of patients with gastroesophageal reflux disease develop Barrett’s esophagus. This is considered a premalignant condition because it can progress from metaplasia to high-grade dysplasia, and eventually to adenocarcinoma. Recently, major advances have been made in the endoscopic treatment of Barrett’s esophagus, therefore limiting the role of surgery in the treatment of this disease.
Gastroesophageal reflux disease affects an estimated 20% of the population in the United States. About 10%-15% of patients with gastroesophageal reflux disease develop Barrett’s esophagus, which eventually can progress to adenocarcinoma, which is currently the fastest growing cancer in the United States. It is recognized that adenocarcinoma is in most cases the end stage of a sequence of events whereby the squamous esophageal epithelium is initially replaced by columnar epithelium without dysplasia. Subsequently, the metaplastic epithelium can progress to low- and high-grade dysplasia and eventually cancer[1-3].
This symposium addresses some key questions in the treatment of this disease process. The pathophysiology and diagnosis of the disease are reviewed, particularly in morbidly obese patients[4-10]. Based on the pathophysiology, the treatment of metaplasia is discussed. Special attention has been placed on new treatment modalities such as radiofrequency ablation and endoscopic mucosal resection, which have revolutionized the treatment of high-grade dysplasia and intramucosal carcinoma[11-16]. The remaining indications for esophagectomy in these cases are discussed[17]. Finally, we have reviewed what to do when invasive cancer is present, discussing the role of neoadjuvant therapy[18-20], the type of esophageal resection (trans-hiatal versus trans-thoracic)[21,22], and the current data available about minimally invasive esophagectomy[23,24]. The authors are both experts dedicated to the treatment of patients with esophageal disorders and have published extensively on these topics.
Citation: Patti MG, Waxman I. Gastroesophageal reflux disease: From heartburn to cancer. World J Gastroenterol 2010; 16(30): 3743-3744
Sandler RS, Everhart JE, Donowitz M, Adams E, Cronin K, Goodman C, Gemmen E, Shah S, Avdic A, Rubin R. The burden of selected digestive diseases in the United States.Gastroenterology. 2002;122:1500-1511.
[PubMed] [DOI]
Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence.J Natl Cancer Inst. 2005;97:142-146.
[PubMed] [DOI]
Prach AT, MacDonald TA, Hopwood DA, Johnston DA. Increasing incidence of Barrett's oesophagus: education, enthusiasm, or epidemiology?Lancet. 1997;350:933.
[PubMed] [DOI]
Ganz RA, Overholt BF, Sharma VK, Fleischer DE, Shaheen NJ, Lightdale CJ, Freeman SR, Pruitt RE, Urayama SM, Gress F. Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry.Gastrointest Endosc. 2008;68:35-40.
[PubMed] [DOI]
Chennat J, Konda VJ, Ross AS, de Tejada AH, Noffsinger A, Hart J, Lin S, Ferguson MK, Posner MC, Waxman I. Complete Barrett's eradication endoscopic mucosal resection: an effective treatment modality for high-grade dysplasia and intramucosal carcinoma--an American single-center experience.Am J Gastroenterol. 2009;104:2684-2692.
[PubMed] [DOI]
Wassenaar EB, Oelschlager BK. Effect of medical and surgical treatment of Barrett’s metaplasia.World J Gastroenterol. 2010;16:3773-3779.
[PubMed] [DOI]
Chennat J, Waxman I. Endoscopic treatment of Barrett’s esophagus: From metaplasia to intramucosal carcinoma.World J Gastroenterol. 2010;16:3780-3785.
[PubMed] [DOI]
Konda VJA, Ferguson MK. Esophageal resection for high-grade dysplasia and intramucosal carcinoma: When and how?World J Gastroenterol. 2010;16:3786-3792.
[PubMed] [DOI]
Greil R, Stein HJ. Is it time to consider neoadjuvant treatment as the standard of care in oesophageal cancer?Lancet Oncol. 2007;8:189-190.
[PubMed] [DOI]
Urschel JD, Vasan H, Blewett CJ. A meta-analysis of randomized controlled trials that compared neoadjuvant chemotherapy and surgery to surgery alone for resectable esophageal cancer.Am J Surg. 2002;183:274-279.
[PubMed] [DOI]
Omloo JM, Lagarde SM, Hulscher JB, Reitsma JB, Fockens P, van Dekken H, Ten Kate FJ, Obertop H, Tilanus HW, van Lanschot JJ. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial.Ann Surg. 2007;246:992-1000; discussion 1000-1001.
[PubMed] [DOI]
Gasper WJ, Glidden DV, Jin C, Way LW, Patti MG. Has recognition of the relationship between mortality rates and hospital volume for major cancer surgery in California made a difference?: A follow-up analysis of another decade.Ann Surg. 2009;250:472-483.
[PubMed] [DOI]
