Medscape: Barrett's and EC

[daw]

Barrett's Esophagus and Esophageal Adenocarcinoma
Posted 08/22/2003

from Medscape Primary Care

Question

What is the incidence and lifetime prevalence of adenocarcinoma of the esophagus among cohorts of patients with Barrett's?

Response
from M. Brian Fennerty, MD, 08/22/2003

This question cannot be accurately answered because there are no good cohort studies of Barrett's esophagus patients without dysplasia. Indeed, some experts have suggested that estimates in the literature have grossly overestimated the true incidence because of publication bias. What is known is that all Barrett's esophagus patients have a 30- to 100-fold increased risk of cancer, but given that the absolute incidence of this cancer is low, the overall rate in Barrett's esophagus patients remains low despite this magnitude of increased risk. Most have suggested that the data indicate that an individual with Barrett's esophagus without dysplasia has a lifetime risk of less than 5%. The annual incidence of dysplasia among Barrett's esophagus patients without dysplasia appears to be less than 1% in a recent consortium database of over 1000 such patients.

Suggested Readings

Shaheen N, Ransohoff DF. Gastroesophageal reflux, Barrett's esophagus and esophageal cancer. JAMA. 2002;287:1972-1981.

Sharma P, Reker D, Falk G, et al. Progression of Barrett's esophagus to high-grade dysplasia and cancer: Preliminary results of the BEST trial. Gastroenterology. 2001;120:A16.
About the Panel Members
M. Brian Fennerty, MD, Professor of Medicine, Section Chief of Gastroenterology, Oregon Health Sciences University, Portland, Oregon

[tmca]

Daw, I also read most of these articles but they are very confusing and conflicting with information.......I do belive the risk of progressing to EC is fairly low, however, all studies also indicate that adenocarcinoma of the esophagus has become the fastest growing cancer in the USA......Im also not sure that 5% of non-dysplasia barretts esophagus progressing to EC over their lifetime is really such good odds..That is 5 out of every 100 non-dysplasia pts....When you have dysplasia your odds greatly increase....Im most concerned over the large amt of people who have been erroneously diagnosed with barretts....Been treated for months (or years)and underwent the biopsies often and then sought 2nd opinions from large training hosp. and found out they never had barretts in first place..Biopsies were taken from wrong area or were read wrong.....I think the medical profession should really work on getting that resolved....Some of us on this board also belong to another online barretts support board and we hear about this happening over and over.....Take care, Tessa

[daw]

Originally posted by tmca
...Im most concerned over the large amt of people who have been erroneously diagnosed with barretts....Been treated for months (or years)and underwent the biopsies often and then sought 2nd opinions from large training hosp. and found out they never had barretts in first place..Biopsies were taken from wrong area or were read wrong.....I think the medical profession should really work on getting that resolved....

I definitely agree with this and it has been bothering me for quite some time. The stress one faces when diagnosed with Barrett's is terrible and that only compounds the problem. To find out that one was diagnosed erroneously may be a relief but unfortunately the
stress has already taken it's toll....not to mention the loss of trust.

Also, for those who never seek a second opinion, the diagnosis of Barrett's will stay with them forever...no matter how many future biopsies show no intestinal metaplasia. At what point do you decide to try and find out what's going on? How long does a lab hold onto your biopsy slides?

For some, especially with the shorter segments of Barrett's, the inconsistancy of the biopsies is mind boggling and a definite emotional rollarcoaster ride. To have intestinal metaplasia found one year , not the next and then again the next, etc. makes one realize the limitations of this procedure or of the doctor performing it. There are many articles out there addressing this very subject.

[tmca]

Daw,We have learned with this illness to be proactive in our care and search for good Drs...Pertaining to biopsies and who reads them.....I have been having a problem with one lab reading all my biopsies at high-grade and sending them to a different lab comes back at low-grade...I took the slides with me to CC and they were read low-grade..However my Dr. there is going to do his own set of jumbo biopsies when I return...The best advise I have received about dealing with GIs over these conflicting reports came from a Dr. who advised me to ask the following questions...1. "How certain are you that the biopsies you obtained accuratly reflect the entire effected area of my esophagus?" And....2. "How certain are you that the lab you are sending them to, to be analyzed ,would have their results confirmed by a 2nd opinion?" He told me you can also ask..."To what lab would you be sending these biopsy slides if it were your spouse in this situation?" With this disease I think we should ALL ask these type questions of our GIs......Have a good holiday...Tessa