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1 Division of Gastroenterology and Hepatology, University of Kansas School of Medicine and VA Medical Center, Kansas City, Missouri, USA
2 Division of Gastroenterology and Hepatology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
Correspondence to:
Correspondence to:
Dr P Sharma
Division of Gastroenterology,VA Medical Center, 4801 E. Linwood Boulevard, Kansas City, Missouri, MO 64128, USA; psharma{at}kumc.edu
ABSTRACT
Oesophageal adenocarcinoma has a low incidence and still remains an uncommon cancer; however, it has been on the rise over the past 20 years. Barrett’s oesophagus, a complication of gastro-oesophageal reflux disease, is the only known precursor of this adenocarcinoma. It can often be asymptomatic and probably goes undiagnosed in the majority of the population. There are no direct data supporting the practice of screening for Barrett’s oesophagus and oesophageal adenocarcinoma among the general population or even in patients with chronic reflux symptoms. However, many argue that the detection of neoplasms at a curable state in a high risk population can perhaps justify screening endoscopy. No prospective, controlled trials have been conducted to support the effectiveness of surveillance, but some indirect evidence does exist. The cost effectiveness of surveillance programmes needs to be further assessed in prospective studies. Ultimately, the use of better tools to diagnose Barrett’s oesophagus and dysplasia and the identification of high risk groups for progression to oesophageal adenocarcinoma could potentially make screening and surveillance a cost effective practice.
Abbreviations: BMI, body mass index; GORD, gastro-oesophageal reflux disease; HGD, high grade dysplasia; LOH, loss of heterozygosity; PDT, photodynamic therapy
Keywords: Barrett’s oesophagus; adenocarcinoma; screening
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