Barrett’s Esophagus, a Pre-cancerous Disease, is
Increasing Among White Male Senior Citizens
Study says doctors can do more about this disease
linked to chronic acid reflux
Aug.
7, 2008 - It is another one of those diseases that does not usually
strike until you are about to become a senior citizen, which may be one
of the reasons the disease known as Barrett’s esophagus gets overlooked.
A new study says the medical community can do a better job with this
pre-cancerous condition linked to chronic acid reflux.
“Barrett's esophagus is a condition in which the
esophagus, the muscular tube that carries food and saliva from the mouth
to the stomach, changes so that some of its lining is replaced by a type
of tissue similar to that normally found in the intestine, according to
a report by National Digestive Diseases Information Clearinghouse (NDDIC).
“This process is called intestinal metaplasia.”
“While Barrett's esophagus may cause no symptoms
itself, a small number of people with this condition develop a
relatively rare but often deadly type of cancer of the esophagus called
esophageal adenocarcinoma. Barrett's esophagus is estimated to affect
about 700,000 adults in the United States. It is associated with the
very common condition gastroesophageal reflux disease or GERD.”
The average age at diagnosis is 60, but it is
usually difficult to determine when the problem started. It is about
twice as common in men as in women, and much more common in white men
than in men of other races.
Barrett's esophagus does not cause symptoms itself
and is important only because it seems to precede the development of a
particular kind of cancer—esophageal adenocarcinoma. The risk of
developing adenocarcinoma is 30 to 125 times higher in people who have
Barrett's esophagus than in people who do not. This type of cancer is
increasing rapidly in white men and this increase may be related to the
rise in obesity and GERD.
But, for people who have Barrett's esophagus, the
risk of getting cancer of the esophagus is small: less than 1 percent
(0.4 percent to 0.5 percent) per year. Esophageal adenocarcinoma,
however, is often not curable, partly because the disease is frequently
discovered at a late stage and because treatments are not effective.
Researchers from the Hutchinson-MRC Research Centre
in Cambridge decided more could be done to diagnose and treat this often
deadly disease.
In a review published in the inaugural issue of
Disease Models & Mechanisms (DMM), these experts on Barrett's esophagus
discuss how "Barrett's" presents unique challenges in diagnosis and
treatment. They cite key factors which make this illness difficult to
detect, and suggest how scientists and doctors can team up to improve
the odds of intervention.
Doctors want to understand more about this
condition because patients with Barrett's have 30 to 125 times increased
risk of an often fatal cancer of the esophagus. One of the most common
indicators of Barrett's is severe and chronic acid reflux.
The authors of the review article discuss several
reasons why most Barrett's cases are undiagnosed.
The wide-spread availability of over-the-counter
antacid medications may contribute by suppressing symptoms such that
only the most severe and persistent cases of acid reflux are recommended
for screening.
Additionally, in order to screen for Barrett's, the
esophagus must be examined with a small light and camera (endoscope)
which is not a routine procedure.
The biological basis of Barrett's is an abnormal
change, or dysplasia, in the esophagus. Normally, the esophagus is lined
with flat-shaped cells known as squamous cells. However, in patients
with Barrett's, the cell lining consists of rectangular-shaped columnar
cells.
This process of normal cells morphing into abnormal
cells is common to several types of cancer, not just esophageal cancer.
Thus, a greater understanding of Barrett's can also lead to potential
therapies for similar pre-cancerous conditions.
In order to advance the diagnosis of Barrett's
esophagus, researchers recommend identifying standardized indicators
which can be used to identify the presence of Barrett's as well as
predict the likelihood that it will progress into cancer. Additionally,
they recommend developing less costly screening methods to allow routine
checks for Barrett's in patients with acid reflux.
They point out the need for developing laboratory
animal models of this disease in order to study the underlying molecular
mechanisms of Barrett's, as well as to test potential novel therapies.
Editor's Notes:
The review was written by Massimilian di Pietro,
Christopher J. Peters and Rebecca C. Fitzgerald of the Hutchinson-MRC
Research Centre in Cambridge, UK. The report was published in the
inaugural July/August issue of a new research journal, Disease Models &
Mechanisms (DMM), published by The Company of Biologists, a non-profit
based in Cambridge, UK.
Disease Models & Mechanisms (DMM) is a new research
journal publishing both primary scientific research, as well as review
articles, editorials, and research highlights. The journal's mission is
to provide a forum for clinicians and scientists to discuss basic
science and clinical research related to human disease, disease
detection and novel therapies. DMM is published by the Company of
Biologists, a non-profit organization based in Cambridge, UK. The
Company also publishes the international biology research journals
Development, Journal of Cell Science, and The Journal of Experimental
Biology.
Aug.
7, 2008 - It is another one of those diseases that does not usually
strike until you are about to become a senior citizen, which may be one
of the reasons the disease known as Barrett’s esophagus gets overlooked.
A new study says the medical community can do a better job with this
pre-cancerous condition linked to chronic acid reflux.