National Institute for Health and Care Excellence (NICE) guidance on monitoring and management of Barrett's oesophagus and stage I oesophageal adenocarcinoma
National Institute for Health and Care Excellence (NICE) guidance on monitoring and management of Barrett's oesophagus and stage I oesophageal adenocarcinoma
Barrett's oesophagus is the only known precursor to oesophageal adenocarcinoma, a cancer with very poor prognosis. The main risk factors for Barrett's oesophagus are a history of gastro-oesophageal acid reflux symptoms and obesity. Men, smokers and those with a family history are also at increased risk. Progression from Barrett's oesophagus to cancer occurs via an intermediate stage, known as dysplasia. However, dysplasia and early cancer usually develop without any clinical signs, often in individuals whose symptoms are well controlled by acid suppressant medications; therefore, endoscopic surveillance is recommended to allow for early diagnosis and timely clinical intervention. Individuals with Barrett's oesophagus need to be fully informed about the implications of this diagnosis and the benefits and risks of monitoring strategies. Pharmacological treatments are recommended for control of symptoms, but not for chemoprevention. Dysplasia and stage 1 oesophageal adenocarcinoma have excellent prognoses, since they can be cured with endoscopic or surgical therapies. Endoscopic resection is the most accurate staging technique for early Barrett's-related oesophageal adenocarcinoma. Endoscopic ablation is effective and indicated to eradicate Barrett's oesophagus in patients with dysplasia. Future research should focus on improved accuracy for dysplasia detection via new technologies and providing more robust evidence to support pathways for follow-up and treatment.
ANTI-REFLUX SURGERY, BARRETT'S OESOPHAGUS, OESOPHAGEAL CANCER, PROTON PUMP INHIBITION, SURVEILLANCE
897-909
di Pietro, Massimiliano
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Trudgill, Nigel J.
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Vasileiou, Melina
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Longcroft-Wheaton, Gaius
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Phillips, Alexander W.
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Gossage, James
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Kaye, Philip V.
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Foley, Kieran G.
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Crosby, Tom
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Nelson, Sophie
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Griffiths, Helen
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Rahman, Muksitur
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Ritchie, Gill
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Crisp, Amy
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Deed, Stephen
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Primrose, John N.
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10 May 2024
di Pietro, Massimiliano
3c06daab-5d65-4ec3-a086-27224934a13c
Trudgill, Nigel J.
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Vasileiou, Melina
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Longcroft-Wheaton, Gaius
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Phillips, Alexander W.
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Gossage, James
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Kaye, Philip V.
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Foley, Kieran G.
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Crosby, Tom
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Nelson, Sophie
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Griffiths, Helen
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Rahman, Muksitur
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Ritchie, Gill
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Crisp, Amy
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Deed, Stephen
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Primrose, John N.
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di Pietro, Massimiliano, Trudgill, Nigel J., Vasileiou, Melina, Longcroft-Wheaton, Gaius, Phillips, Alexander W., Gossage, James, Kaye, Philip V., Foley, Kieran G., Crosby, Tom, Nelson, Sophie, Griffiths, Helen, Rahman, Muksitur, Ritchie, Gill, Crisp, Amy, Deed, Stephen and Primrose, John N.
(2024)
National Institute for Health and Care Excellence (NICE) guidance on monitoring and management of Barrett's oesophagus and stage I oesophageal adenocarcinoma.
Gut, 73 (6), , [gutjnl-2023-331557].
(doi:10.1136/gutjnl-2023-331557).
Abstract
Barrett's oesophagus is the only known precursor to oesophageal adenocarcinoma, a cancer with very poor prognosis. The main risk factors for Barrett's oesophagus are a history of gastro-oesophageal acid reflux symptoms and obesity. Men, smokers and those with a family history are also at increased risk. Progression from Barrett's oesophagus to cancer occurs via an intermediate stage, known as dysplasia. However, dysplasia and early cancer usually develop without any clinical signs, often in individuals whose symptoms are well controlled by acid suppressant medications; therefore, endoscopic surveillance is recommended to allow for early diagnosis and timely clinical intervention. Individuals with Barrett's oesophagus need to be fully informed about the implications of this diagnosis and the benefits and risks of monitoring strategies. Pharmacological treatments are recommended for control of symptoms, but not for chemoprevention. Dysplasia and stage 1 oesophageal adenocarcinoma have excellent prognoses, since they can be cured with endoscopic or surgical therapies. Endoscopic resection is the most accurate staging technique for early Barrett's-related oesophageal adenocarcinoma. Endoscopic ablation is effective and indicated to eradicate Barrett's oesophagus in patients with dysplasia. Future research should focus on improved accuracy for dysplasia detection via new technologies and providing more robust evidence to support pathways for follow-up and treatment.
Text
gutjnl-2023-331557.full
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More information
Accepted/In Press date: 15 February 2024
e-pub ahead of print date: 29 March 2024
Published date: 10 May 2024
Additional Information:
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.
Publisher Copyright:
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.
Keywords:
ANTI-REFLUX SURGERY, BARRETT'S OESOPHAGUS, OESOPHAGEAL CANCER, PROTON PUMP INHIBITION, SURVEILLANCE
Identifiers
Local EPrints ID: 488831
URI: http://eprints.soton.ac.uk/id/eprint/488831
ISSN: 1468-3288
PURE UUID: a4231f4e-30f4-4793-84fb-87259a5693b3
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Date deposited: 08 Apr 2024 16:31
Last modified: 04 Jun 2024 01:33
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Contributors
Author:
Massimiliano di Pietro
Author:
Nigel J. Trudgill
Author:
Melina Vasileiou
Author:
Gaius Longcroft-Wheaton
Author:
Alexander W. Phillips
Author:
James Gossage
Author:
Philip V. Kaye
Author:
Kieran G. Foley
Author:
Tom Crosby
Author:
Sophie Nelson
Author:
Helen Griffiths
Author:
Muksitur Rahman
Author:
Gill Ritchie
Author:
Amy Crisp
Author:
Stephen Deed
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