Chemoprevention of Barrett's Esophagus and Adenocarcinoma

Abstract

Barrett's esophagus (BE) is an acquired disorder in which metaplastic columnar epithelium replaces the stratified squamous epithelium that normally lines the lower part of the esophagus. The disorder develops as a consequence of chronic gastroesophageal reflux disease and predisposes to the development of esophageal adenocarcinoma (EAC). EAC is strongly associated with BE and it has become increasingly common in developed countries over the last four decades. Endoscopic surveillance is one of the mainstays in the management of BE, however, whether only endoscopic surveillance leads to reduced mortality from EAC in patients with BE remains unclear. Since EAC is associated with poor outcomes even in earlier stages, BE represents an attractive target for chemoprevention. As gastric acid and duodenal bile reflux, obesity, diet and life, hypergastrinemia, Helicobacter pylori infection, and altered molecular mechanisms are possible important factors in pathogenesis of BE, they are also potential targets for chemoprevention to prevent or slow malignant transformation of BE. To date, different chemopreventive agents including proton pump inhibitors, aspirin/nonsteroid antiinflammatory steroids, ursodeoxycholic acid, statins, and metformin have been evaluated in preclinical and clinical studies. In the future, as our understanding of molecular mechanisms involved in BE oncogenesis improves, we hope to employ effective strategies in order to prevent or slow down neoplastic progression. © 2016 Elsevier Inc. All rights reserved.