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

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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

Last reviewed 01/2018

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