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Barrett's oesophagus

Alternative News:

• Statins and Aspirin for Chemoprevention in Barrett's Esophagus: Results of a Cost-Effectiveness Analysis - "Cancer Prev Res (Phila). 2013 Dec 31 - "aspirin chemoprevention was both more effective and cost less than endoscopic surveillance alone. Combination therapy using both aspirin and statin is expensive but could be cost-effective in patients at higher risk of progression to EAC"
• Vegetable, fruit and nitrate intake in relation to the risk of Barrett's oesophagus in a large Dutch cohort - Br J Nutr. 2013 Dec 5:1-11 - "The Netherlands Cohort Study recruited 120 852 individuals aged 55-69 years in 1986. Vegetable and fruit intake was assessed using a 150-item FFQ, and nitrate intake from dietary sources and drinking water was determined ... 16.3 years of follow-up ... Men exhibited a lower risk of Barrett's oesophagus in the highest v. the lowest quintile of total (multivariable-adjusted hazard ratio (HR): 0.66, 95 % CI 0.43, 1.01), raw (HR 0.63, 95 % CI 0.40, 0.99), raw leafy (HR 0.55, 95 % CI 0.36, 0.86) and Brassica (HR 0.64, 95 % CI 0.41, 1.00) vegetable intake. No association was found for other vegetable groups and fruits. No significant associations were found between vegetable and fruit intake and Barrett's oesophagus risk among women. Total nitrate intake was inversely associated with Barrett's disease risk in men (HR 0.50, 95 % CI 0.25, 0.99) and positively associated with it in women (HR 3.77, 95 % CI 1.68, 8.45) (P for interaction = 0.04)"
• Intakes of Dietary Folate and Other B Vitamins Are Associated with Risks of Esophageal Adenocarcinoma, Barrett's Esophagus, and Reflux Esophagitis - J Nutr. 2013 Oct 16 - "Esophageal adenocarcinoma (EAC) may develop through a process involving inflammation [reflux esophagitis (RE)] leading to metaplasia [Barrett's esophagus (BE)] and carcinoma ... EAC risk decreased with increasing folate intake (OR highest vs. lowest = 0.56; 95% CI: 0.31-1.00; P-trend < 0.01). Similar trends were found for BE (P-trend < 0.01) and RE (P-trend = 0.01). Vitamin B-6 intake was significantly inversely related to risks of all 3 lesions. Riboflavin intake was inversely associated with RE. Vitamin B-12 intake was positively associated with EAC. For EAC, there was a borderline significant interaction between folate intake and smoking (P-interaction = 0.053); compared with nonsmokers with high (≥median) folate intake, current smokers with low intakes (<median) had an 8-fold increased risk (OR: 8.15, 95% CI: 3.61-18.40). The same group had increased BE risk (OR: 2.93"
• Dietary intake of vegetables, folate, and antioxidants and the risk of Barrett's esophagus - Cancer Causes Control. 2013 Feb 19 - "When highest tertile of intake was compared with the lowest, the OR (95 % CI) was 0.46 (0.26-0.81) for dark green vegetables, 0.52 (0.30-0.90) for legumes, 0.50 (0.28-0.90) for total fiber, 0.45 (0.25-0.81) for isoflavones, 0.52 (0.30-0.67) for total folate, and 0.45 (0.26-0.79) for lutein, adjusting for multiple confounding factors including use of aspirin or proton pump inhibitor, gastro-esophageal reflux symptoms, and physical activity. The association for dark green vegetables was attenuated after adjustment for lutein, total fiber, and total folate (OR = 0.82; 95 % CI 0.30-2.22)"
• Dietary fat and meat intakes and risk of reflux esophagitis, Barrett's esophagus and esophageal adenocarcinoma - Int J Cancer. 2011 Mar 31 - "The aim of this study was to investigate whether dietary fat and meat intakes are associated with reflux esophagitis (RE), Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) ... Patients in the highest quartile of total fat intake had a higher risk of RE (OR=3.54; 95%CI=1.32-9.46) and EAC (OR=5.44; 95%CI=2.08-14.27). A higher risk of RE and EAC was also reported for patients in the highest quartile of saturated fat intake (OR=2.79; 95%CI=1.11-7.04; OR=2.41; 95%CI=1.14-5.08, respectively) and monounsaturated fat intake (OR=2.63; 95%CI=1.01-6.86; OR=5.35; 95%CI=2.14-13.34, respectively). Patients in the highest quartile of fresh red meat intake had a higher risk of EAC (OR=3.15; 95%CI=1.38-7.20). Patients in the highest category of processed meat intake had a higher risk of RE (OR=4.67; 95%CI=1.71-12.74). No consistent associations were seen for BE with either fat or meat intakes"

News & Research:

• Proton Pump Inhibitor Use May Not Prevent High-grade Dysplasia and Oesophageal Adenocarcinoma in Barrett's Oesophagus - Medscape, 5/1/14 - "The relative risk of oesophageal adenocarcinoma or high-grade dysplasia was 2.2 (0.7–6.7) and 3.4 (95% CI: 1.1–10.5) in long-term low- and high-adherence PPI users respectively ... PPI use may facilitate the formation of carcinogenic bile acids, explaining some of our findings ... increased gastrin production may also influence the scenario"
• Treatment helps reduce risk of esophagus disorder progressing to cancer - 3/25/14 - "Among patients with the condition known as Barrett esophagus, treatment of abnormal cells with radiofrequency ablation (use of heat applied through an endoscope to destroy cells) resulted in a reduced risk of this condition progressing to cancer ... ablation was associated with reduced absolute risk of progression to high-grade dysplasia or cancer of 25 percent (1.5 percent vs 26.5 percent for control) and a reduced absolute risk of progression to cancer of 7.4 percent (1.5 percent vs 8.8 percent) ... The trial was terminated early due to the superiority of ablation for the primary outcome and concerns about patient safety should the trial continue"
• 'Stop Scaring Patients': How Esophageal Cancer Evolves - Medscape, 12/23/13 - "only about 5% of reflux patients are diagnosed with Barrett’s esophagus on endoscopy, and of those, only a minuscule proportion (0.3% - 0.7%) progress to cancer each year ... there is no cure for Barrett's, and if you test positive you will be buying into repeated endoscopies for the rest of your life"