Adenocarcinoma in Barrett esophagus: Too common, too fatal, and still too badly managed

Abstract

Gastrointestinal cancer accounts for approximately 25 of all cancers and approximately 9 of all deaths worldwide. Cancer is the cause of death in 25 of cases in the United Kingdom compared with 22 in the United States. Although death rates of most of the top 10 cancers have decreased in the last decade, male esophageal cancers are on the rise (3 increase). Screening the population for Barrett metaplasia is not cost-effective exercise especially if patients are asymptomatic. Moreover, though surveillance is now widely done for Barrett metaplasia both for short-segment and long-segment, the incidence of esophageal cancer is much higher than expected, as most of these do not come to light until late in the elderly. The best therapeutic strategy hence would be chemoprevention. This review paper mainly addresses the issues such as the epidemiology of adenocarcinoma in Barrett esophagus; the rationale for prevention; why chemoprevention would be the best option and will describe the major trial on chemoprevention in Barrett Metaplasia (Aspirin Esomeprazole Chemoprevention Trial). © 2007 Lippincott Williams & Wilkins, Inc.