An investigation of the progression from Barrett's esophagus to adenocarcinoma
Palmese, Scott Joseph
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Barrett's esophagus is a metaplasia of the epithelium of the lower esophagus from a normal squamous appearance to a columnar appearance more typically found in the stomach. It is normally caused by prolonged gastric reflux. While Barrett's esophagus is not usually the direct cause of adverse symptoms, it does put a person at greater risk for developing esophageal adenocarcinoma, one of the least treatable cancers currently known. While the progression from gastric reflux to Barrett's esophagus is fairly clear, the relationship between Barrett's esophagus and esophageal adenocarcinoma is not as well understood. Not all patients diagnosed with Barrett's esophagus will go on to develop esophageal adenocarcinoma. There are several factors that may have some impact on this progression, including obesity, lifestyle, and genetic predisposition. The purpose of this study was to evaluate the literature to determine the potential impacts of each of these factors on development of esophageal adenocarcinoma. While obesity and lifestyle clearly have some impact on development of esophageal adenocarcinoma, it was found that the exact nature of that impact is still unclear. Obesity leads to several consequences, including increased gastroesophageal reflux, hormonal changes, and reduction in the bacterium H. pylori, all of which have been shown to have some impact on metaplasia in the esophagus. Lifestyle choices, including alcohol or tobacco use, also have been shown to have at least some effect on development of esophageal adenocarcinoma. The literature also reveals that inherited risk factors, namely genetic predisposition, may play a role in development of esophageal adenocarcinoma. Genetic predisposition to obesity may have some impact, but other studies have identified genetic variations that seem to directly influence development of esophageal adenocarcinoma. While it is clear that there are several factors that influence development of esophageal adenocarcinoma, we do not yet understand the complete etiology. By continuing to study these risk factors, we will be able to develop new treatments to combat the rising incidence of Barrett's esophagus and esophageal adenocarcinoma.