Image: A histopathology of Barrett\'s esophagus, characterized by the presence of specialized columnar epithelium with goblet cells (Photo courtesy of Dr. John R Goldblum, MD).
Barrett's esophagus refers to an abnormal change (metaplasia) in the cells of the lower portion of the esophagus. It is characterized by the replacement of the normal stratified squamous epithelium lining of the esophagus by simple columnar epithelium with goblet cells.
While it is well known that esophageal adenocarcinoma is a common complication of Barrett’s esophagus, the significance of family history of esophageal adenocarcinoma in disease progression among patients with Barrett’s esophagus is not well-known. Patients with Barrett’s esophagus who have a first-degree relative with esophageal adenocarcinoma are at 5.5-fold increased risk for progression to esophageal adenocarcinoma.
Scientists at Thomas Jefferson University Hospital (Philadelphia, PA, USA) conducted a retrospective cohort study including 301 patients with Barrett’s esophagus undergoing radiofrequency ablation at a tertiary care center. The investigators pooled data from electronic medical records on patient age, sex, age at diagnosis of Barrett’s esophagus and esophageal adenocarcinoma, pathology and length of Barrett’s esophagus segment. They assessed information on family history in all patients, including those with and without esophageal adenocarcinoma.
The team excluded from the study 19 patients with intramucosal adenocarcinoma on index endoscopy. Overall, 6.7% of patients with Barrett’s esophagus had a first-degree relative with a history of esophageal adenocarcinoma. Of these, 21.1% had disease that progressed to esophageal adenocarcinoma compared with 8.7% of patients without a first-degree relative with esophageal adenocarcinoma. After adjusting for sex and the number of radiofrequency ablation treatments, they found that family history of esophageal adenocarcinoma was a significant independent predictor for progression to adenocarcinoma (OR=5.55; 95% CI, 1.47-20).
Christina J. Tofani, MD, a gastroenterologist and lead author of the study, said, “Our study suggests that family history of esophageal adenocarcinoma is an independent risk factor for the development of esophageal adenocarcinoma in Barrett’s esophagus patients and should be carefully considered in patient surveillance and radiofrequency ablation treatment, beyond current recommended guidelines.” The study was presented at the World Congress of Gastroenterology at American College of Gastroenterology Annual Scientific Meeting, held October 13-18, 2017, in Orlando, FL, USA.
Thomas Jefferson University Hospital