PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of wjgLink to Publisher's site
 
World J Gastroenterol. 2010 August 14; 16(30): 3743–3744.
Published online 2010 August 14. doi:  10.3748/wjg.v16.i30.3743
PMCID: PMC2921083

Gastroesophageal reflux disease: From heartburn to cancer

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.

Keywords: Gastroesophageal reflux disease, Barrett’s esophagus, Esophageal adenocarcinoma, Laparoscopic fundoplication, Radiofrequency ablation, Esophageal endoscopic mucosal resection, Minimally invasive esophagectomy

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.

Footnotes

S- Editor Wang YR L- Editor Kerr C E- Editor Lin YP

References

1. 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]
2. 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]
3. Prach AT, MacDonald TA, Hopwood DA, Johnston DA. Increasing incidence of Barrett's oesophagus: education, enthusiasm, or epidemiology? Lancet. 1997;350:933. [PubMed]
4. Kahrilas PJ. Anatomy and physiology of the gastroesophageal junction. Gastroenterol Clin North Am. 1997;26:467–486. [PubMed]
5. Herbella FA, Sweet MP, Tedesco P, Nipomnick I, Patti MG. Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment. J Gastrointest Surg. 2007;11:286–290. [PubMed]
6. Tamhankar AP, Peters JH, Portale G, Hsieh CC, Hagen JA, Bremner CG, DeMeester TR. Omeprazole does not reduce gastroesophageal reflux: new insights using multichannel intraluminal impedance technology. J Gastrointest Surg. 2004;8:890–897; discussion 897-898. [PubMed]
7. Herbella FA, Patti MG. Gastroesophageal reflux disease: From pathophysiology to treatment. World J Gastroenterol. 2010;16:3745–3749. [PMC free article] [PubMed]
8. Gawron AJ, Hirano I. Advances in diagnostic testing for gastroesophageal reflux disease. World J Gastroenterol. 2010;16:3750–3756. [PMC free article] [PubMed]
9. Prachand VN, Alverdy JC. Gastroesophageal reflux disease and severe obesity: Fundoplication or bariatric surgery? World J Gastroenterol. 2010;16:3757–3761. [PMC free article] [PubMed]
10. Oh DS, DeMeester SR. Pathophysiology and treatment of Barrett’s esophagus. World J Gastroenterol. 2010;16:3762–3772. [PMC free article] [PubMed]
11. Ganz RA, Overholt BF, Sharma VK, Fleischer DE, Shaheen NJ, Lightdale CJ, Freeman SR, Pruitt RE, Urayama SM, Gress F, et al. Circumferential ablation of Barrett's esophagus that contains high-grade dysplasia: a U.S. Multicenter Registry. Gastrointest Endosc. 2008;68:35–40. [PubMed]
12. Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, Galanko JA, Bronner MP, Goldblum JR, Bennett AE, et al. Radiofrequency ablation in Barrett's esophagus with dysplasia. N Engl J Med. 2009;360:2277–2288. [PubMed]
13. 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]
14. Wassenaar EB, Oelschlager BK. Effect of medical and surgical treatment of Barrett’s metaplasia. World J Gastroenterol. 2010;16:3773–3779. [PMC free article] [PubMed]
15. Chennat J, Waxman I. Endoscopic treatment of Barrett’s esophagus: From metaplasia to intramucosal carcinoma. World J Gastroenterol. 2010;16:3780–3785. [PMC free article] [PubMed]
16. Konda VJA, Ferguson MK. Esophageal resection for high-grade dysplasia and intramucosal carcinoma: When and how? World J Gastroenterol. 2010;16:3786–3792. [PMC free article] [PubMed]
17. 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]
18. 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]
19. Campbell NP, Villaflor VM. Neoadjuvant treatment of esophageal cancer. World J Gastroenterol. 2010;16:3793–3803. [PMC free article] [PubMed]
20. 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]
21. 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]
22. Barreto JC, Posner MC. Transhiatal versus transthoracic esophagectomy for esophageal cancer. World J Gastroenterol. 2010;16:3804–3810. [PMC free article] [PubMed]
23. Decker G, Coosemans W, De Leyn P, Decaluwé H, Nafteux P, Van Raemdonck D, Lerut T. Minimally invasive esophagectomy for cancer. Eur J Cardiothorac Surg. 2009;35:13–20; discussion 20-21. [PubMed]
24. Herbella FA, Patti MG. Minimally invasive esophagectomy. World J Gastroenterol. 2010;16:3811–3815. [PMC free article] [PubMed]

Articles from World Journal of Gastroenterology are provided here courtesy of Baishideng Publishing Group Inc