Esophagus

Esophageal Adenocarcinoma (EAC) has increased at a faster rate than any other cancer in the US and Europe. Barrett’s esophagus (BE), a condition in which the squamous epithelium of the distal esophagus is replaced by columnar epithelium with intestinal metaplasia, is a well-established risk factor for EAC. BE increases the risk of EAC by more than 40-fold.The etiology of BE is not well characterized. Environmental factors, such as diet and obesity are associated with both BE as well as EAC. The majority of patients with BE have a benign course, whereas 0.5% of patients per year progress from benign to malignant disease. Critically, unless EAC is diagnosed before the invasion of the submucosal layer, it is associated with an abysmal outcome with <15% surviving beyond 5 years despite advances in treatment. This has led to intensive global efforts focused on identifying biomarkers for risk stratification with the aims of reducing mortality from this disease. Early detection would allow for less invasive and less costly interventions. Encouraged by successes seen in other tumor types, many groups have embarked on ambitious omics-based approaches to identify clinically relevant biomarkers. The goal is to be able to distinguish clearly between BE patients who have low and high EAC risk. However, to date, while several biomarkers have been shown to be useful disease indicators, thus far, none have progressed to the stage of clinical implementation. A comprehensive review of current molecular markers that have been implicated in BE is beyond the scope of this editorial but extensively reviewed recently.

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Last date updated on November, 2024