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Barrett's esophagus and the risk of adenocarcinoma.

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  • Additional Information
    • Author(s):
    • Address:
      Sal Nanna Svartz (J3:12), Bioclinicum, Solnavägen 30, Solna, Sweden.
    • Publication Information:
      Sweden
    • Abstract:
      The overall aim of the thesis was to assess risk and prognosis in patients with Barrett's esophagus and esophageal adenocarcinoma. Four studies were conducted based on data from Swedish nationwide registers and medical records from 71 Swedish hospitals. Study I was a population-based cohort study which assessed the risk of esophageal adenocarcinoma among patients with Barrett's esophagus. Among 7,932 study participants with Barrett's esophagus (median age 66 years, 68% men), 89 developed esophageal adenocarcinoma. 27 adenocarcinomas developed over a period of 18,415 person-years, which corresponded to an incidence rate of 1.5 (95% CI 0.9-2.0) cases per 1,000 person-years at risk and a standardized incidence ratio of 9.4 (95% CI 6.2-13.6). Study II was a case-control study designed to identify a prediction model for progression from Barrett's esophagus to adenocarcinoma or high-grade dysplasia. Older age, male sex and longer Barrett's esophagus segment length were associated with increased risk of adenocarcinoma/high-grade dysplasia. Study III was a population-based cohort study which evaluated the adherence to surveillance and treatment guidelines for Barrett's esophagus. Among 211 participants (71% low-grade dysplasia, 29% high-grade dysplasia), 84% had a follow-up endoscopy, 17% received endoscopic therapy and 8% underwent esophagectomy. Risk factors for deviation from surveillance and treatment recommended in guidelines were low-grade dysplasia compared to high-grade dysplasia and longer segment length compared to shorter segment length, while treatment in surgical compared to gastroenterological departments was associated with recommended surveillance and treatment. Study IV was a population-based cohort study which assessed whether endoscopy screening improves the prognosis of esophageal adenocarcinoma. Among 6,600 study participants with adenocarcinoma (mean age 70 years, 79% male) followed for 9,138 person-years, 7% had a history of gastroesophageal reflux disease and 9% underwent endoscopy before cancer diagnosis. The 5-year mortality was decreased in patients with history of gastroesophageal reflux disease (HR 0.71, 95% CI 0.64-0.80), and this decrease was only slightly attenuated by adjustment for prior endoscopy (HR 0.79, 95% CI 0.70-0.90). The 5-year mortality was unchanged in patients with 1-2 screening endoscopies (compared to patients without screening endoscopy), while those with ≥3 endoscopies for gastroesophageal reflux disease had improved survival in esophageal adenocarcinoma (HR 0.55, 95% CI 0.36-0.85). To conclude, the overall risk of adenocarcinoma in Barrett's esophagus is low, but it is possible to predict a clearly higher risk of tumor progression based on a few clinically available risk factors, enabling tailored endoscopy surveillance in these patients.
    • Number of References:
      135 ref.
    • Subject Terms:
      Public Health
    • Subject Terms:
    • Accession Number:
      cancers, Barrett's esophagus, esophagus, esophageal diseases
    • CABICODES:
      Non-communicable Human Diseases and Injuries (VV600)
      Non-drug Therapy and Prophylaxis of Humans (VV710) (New March 2000)
    • Publication Information:
      Thesis; URL:https://openarchive.ki.se/xmlui/handle/10616/46697
    • Accession Number:
      20203185619
    • Copyright:
      ©2019 CAB International
  • Citations
    • ABNT:
      HOLMBERG, D. Barrett’s esophagus and the risk of adenocarcinoma. 2019. Karolinska Institutet, Stockholm; Sweden, 2019. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20203185619. Acesso em: 4 ago. 2020.
    • AMA:
      Holmberg D. Barrett’s esophagus and the risk of adenocarcinoma. Barrett’s esophagus and the risk of adenocarcinoma. 2019:62. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20203185619. Accessed August 4, 2020.
    • AMA11:
      Holmberg D. Barrett’s esophagus and the risk of adenocarcinoma. Barrett’s esophagus and the risk of adenocarcinoma. 2019:62. Accessed August 4, 2020. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20203185619
    • APA:
      Holmberg, D. (2019). Barrett’s esophagus and the risk of adenocarcinoma [Karolinska Institutet]. In Barrett’s esophagus and the risk of adenocarcinoma (p. 62).
    • Chicago/Turabian: Author-Date:
      Holmberg, D. 2019. “Barrett’s Esophagus and the Risk of Adenocarcinoma.” Barrett’s Esophagus and the Risk of Adenocarcinoma. Stockholm; Sweden: Karolinska Institutet. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20203185619.
    • Harvard:
      Holmberg, D. (2019) Barrett’s esophagus and the risk of adenocarcinoma, Barrett’s esophagus and the risk of adenocarcinoma. Karolinska Institutet. Available at: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20203185619 (Accessed: 4 August 2020).
    • Harvard: Australian:
      Holmberg, D 2019, ‘Barrett’s esophagus and the risk of adenocarcinoma’, Karolinska Institutet, Stockholm; Sweden, Barrett’s esophagus and the risk of adenocarcinoma, p. 62, viewed 4 August 2020, .
    • MLA:
      Holmberg, D. “Barrett’s Esophagus and the Risk of Adenocarcinoma.” Barrett’s Esophagus and the Risk of Adenocarcinoma, Karolinska Institutet, 2019, p. 62. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20203185619.
    • Chicago/Turabian: Humanities:
      Holmberg, D. “Barrett’s Esophagus and the Risk of Adenocarcinoma.” Barrett’s Esophagus and the Risk of Adenocarcinoma. Karolinska Institutet, 2019. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20203185619.
    • Vancouver/ICMJE:
      Holmberg D. Barrett’s esophagus and the risk of adenocarcinoma [Internet]. Barrett’s esophagus and the risk of adenocarcinoma. [Stockholm; Sweden]: Karolinska Institutet; 2019 [cited 2020 Aug 4]. p. 62. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20203185619