Barrett's oesophagus and risk of oesophageal adenocarcinoma or oesophageal cancer

Risk of adenocarcinoma of the oesophagus:

Oesophageal adenocarcinoma (AC) risk is more than 11 times higher in people with Barrett's oesophagus (BO) versus the general population, a cohort study showed.[1]

Oesophageal AC develops in around 1 per 1,000 BO patients per year [1,2]

• on the basis of these risk levels 3-10% of people with Barrett’s oesophagus in the UK will develop oesophageal AC in their lifetime

However, previous studies estimate a much higher risk of around 1 oesophageal AC case per 160-190 BO patients per year.[4,5]

• on the basis of these risk levels 7-13% of people with Barrett’s oesophagus in the UK will develop oesophageal AC in their lifetime.[3]

Oesophageal AC risk among BO patients increases with BO extent (higher in long-segment than short-segment) and severity (progressively higher through non-dysplastic[4,6] low-grade dysplastic or high-grade dysplastic).

Oesophageal AC risk among BO patients may be higher in males than females, and in smokers than non-smokers.[7]

Factors affecting risk of oesophageal AC if BO:

• risk of oesophageal AC or BO with high-grade dysplasia, among BO patients, is 71% lower in those using proton pump inhibitors (PPIs), and 36% lower in those using cyclooxygenase (COX) inhibitors, versus non-users, meta-analyses have shown.[8,9]
  
  
• risk reduction with PPI use may be greater in, or limited to, longer-term use.[8]
  
  
• oesophageal AC risk among BO patients is 36% lower in non-steroidal anti-inflammatory drugs (NSAIDs) users versus non-users, and 41-47% lower in statin users, both compared with non-users, meta-analyses have shown.[10-13]
  • risk reduction with statins may be limited to those with high-grade dysplasia and may be confounded by NSAIDs use

Reference

• 1) Hvid-Jensen F, Pedersen L, Drewes AM, Sørensen HT, Funch-Jensen P. Incidence of adenocarcinoma among patients with Barrett's esophagus . N Engl J Med 2011;365(15):1375-83.
• 2) Bhat S, Coleman HG, Yousef F, et al. Risk of malignant progression in Barrett's esophagus patients: results from a large population-based study. J Natl Cancer Inst 2011;103(13):1049-57.
• 3) Gatenby P, Caygill C, Wall C, et al. Lifetime risk of esophageal adenocarcinoma in patients with Barrett's esophagus. World J Gastroenterol 2014;20(28):9611-7.
• 4) Yousef F, Cardwell C, Cantwell MM, Galway K, Johnston BT, Murray L. The incidence of esophageal cancer and high-grade dysplasia in Barrett's esophagus: a systematic review and meta-analysis. Am J Epidemiol 2008;168(3):237-49.
• 5) Sikkema M, de Jonge PJ, Steyerberg EW, Kuipers EJ. Risk of esophageal adenocarcinoma and mortality in patients with Barrett's esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2010;8(3):235-44.
• 6) Desai TK, Krishnan K, Samala N, et al. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett's oesophagus: a meta-analysis. Gut 2012;61(7):970-6.
• 7) Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus . Gut 2014;63(1):7-42.
• 8) Singh S, Garg SK, Singh PP, Iyer PG, El-Serag HB. Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett's oesophagus: a systematic review and meta-analysis. Gut 2014;63(8):1229-37.
• 9) Zhang S, Zhang XQ, Ding XW, et al. Cyclooxygenase inhibitors use is associated with reduced risk of esophageal adenocarcinoma in patients with Barrett's esophagus: a meta-analysis. Br J Cancer 2014;110(9):2378-88.
• 10) Wang F, Lv ZS, Fu YK. Nonsteroidal anti-inflammatory drugs and esophageal inflammation - Barrett's esophagus - adenocarcinoma sequence: a meta-analysis. Dis Esophagus 2010.
• 11) Singh S, Singh AG, Singh PP, et al. Statins are associated with reduced risk of esophageal cancer, particularly in patients with Barrett's esophagus: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2013;11(6):620-9.
• 12) Beales IL, Hensley A, Loke Y. Reduced esophageal cancer incidence in statin users, particularly with cyclo-oxygenase inhibition. World J Gastrointest Pharmacol Ther 2013;4(3):69-79.
• 13) Alexandre L, Clark AB, Cheong E, et al. Systematic review: potential preventive effects of statins against oesophageal adenocarcinoma. Aliment Pharmacol Ther 2012;36(4):301-11.