Transcriptionally active human papillomavirus is strongly associated with Barrett's dysplasia and esophageal adenocarcinoma

Infection and esophageal cancer

The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on infection and cancer, and includes commentaries on the influence of bacterial infections on mucin expression and cancer risk; the role of esophageal bacterial biota in the incidence of esophageal disease; the association between human papilloma virus (HPV) and esophageal squamous cell carcinoma; the role of HPV in esophageal adenocarcinoma; the role of Helicobacter pylori in cardiac carcinoma; and the role of Epstein-Barr virus infection in esophageal cancer.

Endoscopic surveillance of gastrointestinal premalignant lesions: current knowledge and future directions

PURPOSE OF REVIEW

Provide an evidence-based resource for the surveillance of gastrointestinal premalignant lesions, focusing on the scientific articles reported recently.

RECENT FINDINGS

No randomized controlled clinical trials exist to definitively support the efficacy of surveillance programs for Barrett's esophagus and gastric intestinal metaplasia. However, surveillance of these premalignant lesions is recommended by some of the leading organizations. To optimize the usefulness of surveillance programs, targeting high-risk patients might maximize its benefits. A Barrett's esophagus segment of at least 3 cm and evidence of intestinal metaplasia can help stratify those patients at highest risk for progression to esophageal adenocarcinoma. The location, extent, and severity of intestinal metaplasia are indicators of risk of developing gastric cancer. Patients with extensive intestinal metaplasia should be offered endoscopic surveillance. Quality in the baseline colonoscopy is crucial to decrease the risk of interval colorectal cancers. The importance of serrated polyps, as well as their surveillance intervals, is emphasized.

SUMMARY

To optimize the usefulness of surveillance programs, targeting high-risk patients might maximize its benefits. Future research is needed to design more effective surveillance strategies. Recently, emerging imaging techniques hold promise for improving sensitivity of endoscopic surveillance of premalignant conditions in the gastrointestinal tract.

Barrett's Esophagus

OPINION STATEMENT

Barrett's esophagus (BE) is the most important and recognizable precursor lesion for esophageal adenocarcinoma (EAC), which is the one of the fastest-growing cancers in the Western world (600 % in the U.S. in the last 40 years), and therefore it is critical to manage the risk of cancer present in BE. New developments in imaging and molecular markers, as well as an armamentarium of novel and effective endoscopic eradication therapy - especially radio-frequency ablation (RFA) and endoscopic mucosal resection (EMR) - are now available to the interventional endoscopist to help curb the significant rise of esophageal adenocarcinoma (EAC). Endoscopic surveillance is currently recommended by most gastroenterology societies worldwide, although there is no data to support this practice in relation to reducing mortality from EAC. Paradoxically, the cancer risk in Barrett's esophagus is being progressively downgraded, which raises fundamental questions about our understanding of the risk factors and molecular biology of the Barrett's metaplasia-dysplasia-adenocarcinoma sequence. The recent discovery of a strong association of transcriptionally active high-risk human papillomavirus (hr-HPV) with Barrett's dysplasia (BD) and EAC may shed some light on this anomaly. It is imperative that we identify the high-risk group of progressors to EAC. While p53 immunohistochemistry is currently probably the best clinical molecular marker for predicting disease progression in BD, we must think outside the box and cast the net wide in search of additional biomarkers (e.g., high-risk human papilloma virus (hr-HPV)].

Research advances in esophageal diseases: bench to bedside

Over the last year, significant steps have been made toward understanding the pathogenesis of esophageal diseases and translating this knowledge to clinical practice. Gastroesophageal reflux disease (GERD) is the most common outpatient diagnosis in gastroenterology and has a high prevalence in the general population. As many as 40% of patients with GERD have incomplete response to medical therapy, and the pathophysiological mechanisms underlying lack of response are now better understood. Novel medical and minimally invasive interventions are available to optimize management of GERD. Esophageal cancer, regardless of the histological subtype, has among the worst survival statistics among all malignancies. Taking advantage of technological advances in genome sequencing, the mutational spectra in esophageal cancer are now emerging, offering novel avenues for targeted therapies. Early diagnosis is another strand for improving survival. While genome-wide association studies are providing insights into genetic susceptibility, novel approaches to early detection of cancer are being devised through the use of biomarkers applied to esophageal samples and as part of imaging technologies. Dysmotility and eosinophilic esophagitis are the differential diagnoses in patients with dysphagia. New pathophysiological classifications have improved the management of motility disorders. Meanwhile, exciting progress has been made in the endoscopic management of these conditions. Eosinophilic esophagitis is still a relatively new entity, and the pathogenesis remains poorly understood. However, it is now clear that an allergic reaction to food plays an important role, and dietary interventions as well as biologic agents to block the inflammatory cascade are novel, promising fields of clinical research.