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Barrett's esophagus and cancer risk: how research advances can impact clinical practice.
[esophageal adenocarcinoma]
Barrett
's
esophagus
(
BE
)
is
the
only
known
precursor
to
esophageal
adenocarcinoma
(
EAC
)
,
whose
incidence
has
increased
sharply
in
the
last
4
decades
.
The
annual
conversion
rate
of
BE
to
cancer
is
significant
,
but
small
.
The
identification
of
patients
at
a
higher
risk
of
cancer
therefore
poses
a
clinical
conundrum
.
Currently
,
endoscopic
surveillance
is
recommended
in
BE
patients
,
with
the
aim
of
diagnosing
either
dysplasia
or
cancer
at
early
stages
,
both
of
which
are
curable
with
minimally
invasive
endoscopic
techniques
.
There
is
a
large
variation
in
clinical
practice
for
endoscopic
surveillance
,
and
dysplasia
as
a
marker
of
increased
risk
is
affected
by
sampling
error
and
high
interobserver
variability
.
Screening
programs
have
not
yet
been
formally
accepted
,
mainly
due
to
the
economic
burden
that
would
be
generated
by
upper
gastrointestinal
endoscopy
.
Screening
programs
have
not
yet
been
formally
accepted
,
mainly
due
to
the
economic
burden
that
would
be
generated
by
widespread
indication
to
upper
gastrointestinal
endoscopy
.
In
fact
,
it
is
currently
difficult
to
formulate
an
accurate
algorithm
to
confidently
target
the
population
at
risk
,
based
on
the
known
clinical
risk
factors
for
BE
and
EAC
.
This
review
will
focus
on
the
clinical
and
molecular
factors
that
are
involved
in
the
development
of
BE
and
its
conversion
to
cancer
and
on
how
increased
knowledge
in
these
areas
can
improve
the
clinical
management
of
the
disease
.
Diseases
Validation
Diseases presenting
"cancer"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
alpha-thalassemia
benign recurrent intrahepatic cholestasis
cadasil
canavan disease
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
congenital adrenal hyperplasia
congenital diaphragmatic hernia
cowden syndrome
cushing syndrome
cutaneous mastocytosis
dedifferentiated liposarcoma
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
familial hypocalciuric hypercalcemia
familial mediterranean fever
gm1 gangliosidosis
heparin-induced thrombocytopenia
hereditary cerebral hemorrhage with amyloidosis
hirschsprung disease
hodgkin lymphoma, classical
inclusion body myositis
junctional epidermolysis bullosa
kabuki syndrome
kallmann syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
locked-in syndrome
lymphangioleiomyomatosis
monosomy 21
neuralgic amyotrophy
oculocutaneous albinism
oligodontia
oral submucous fibrosis
papillon-lefèvre syndrome
pendred syndrome
pleomorphic liposarcoma
primary effusion lymphoma
proteus syndrome
pyomyositis
pyruvate dehydrogenase deficiency
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
werner syndrome
wiskott-aldrich syndrome
wolf-hirschhorn syndrome
x-linked adrenoleukodystrophy
This symptom has already been validated