| Theme |
GERD in Clinical Practice 2018 -- Current Status and Issues |
| Title |
Clinical Management of Barrett's Esophagus |
| Author |
Yuji Amano |
Diagnostic and Therapeutic Endoscopic Center, New Tokyo Hospital |
| Author |
Hideaki Harada |
Department of Gastroenterology, New Tokyo Hospital |
| Author |
Ryotaro Nakahara |
Department of Gastroenterology, New Tokyo Hospital |
| Author |
Daisuke Murakami |
Department of Gastroenterology, New Tokyo Hospital |
| Author |
Satoshi Suehiro |
Department of Gastroenterology, New Tokyo Hospital |
| Author |
Yasushi Katsuyama |
Department of Gastroenterology, New Tokyo Hospital |
| [ Summary ] |
The incidence of esophageal adenocarcinomas originating from/associated with Barrett's esophagus (BE) has shown a remarkable increase during the last 2 decades in Western countries. In Japan, several clinical factors have been associated with the increased prevalence of gastroesophageal reflux disease (GERD) ; for example, decreasing incidence of Helicobacter pylori (H. pylori) infection, increase in the number of patients diagnosed with obesity, and westernization/changes in lifestyle and dietary habits. Accordingly, the occurrence of Barrett's adenocarcinoma has also been gradually increasing accompanied by a rapid increase in the number of patients diagnosed with GERD. Thus, the appropriate management of GERD and effective endoscopic surveillance methods for BE have been gaining wide attention in recent times. Surveillance methods using random biopsies that are recommended in Western countries do not seem applicable in Japanese patients with BE, because most patients present with short segmental type and Japanese endoscopists utilize a superior technique to endoscopically diagnose superficial Barrett's adenocarcinoma via the use of image-enhanced endoscopy (IEE). In Japan, the targeted biopsy method using IEE aimed at BE with a high malignant potential is considered to play an important role in effective Barrett's surveillance. Therefore, in the near future, it would be important to investigate and identify the serious risk factors associated with Barrett's carcinogenesis including the length of BE, age, male gender, obesity, smoking, reflux esophagitis, H. pylori infection, and colonic tumors, among other factors. |