Letters to the Editor

In reply: Barrett esophagus: Definition, treatment

Tavankit Singh, MD, Vedha Sanghi, MD and Prashanthi N. Thota, MD, FACG
Cleveland Clinic Journal of Medicine February 2020, 87 (2) 75-76; DOI: https://doi.org/10.3949/ccjm.87c.02002

Dr. Lai points out that the broader definition of Barrett esophagus can include the presence of metaplastic columnar epithelium that replaces the normal stratified squamous epithelium in the distal esophagus. Guidelines of both the American College of Gastroenterology1 and the American Gastroenterological Association2 require the presence of intestinal mucosa for the diagnosis of Barrett esophagus, as only intestinal metaplasia is associated with the risk of malignant transformation. Therefore, we recommend using the same standard definition.

The second point concerns the duration of therapy in Barrett esophagus. We recommend therapy with proton pump inhibitors indefinitely.

Lastly, we agree that use of statins has shown improved outcomes in patients with esophageal cancer,3 but the existing data on this topic are limited, and a specific recommendation regarding use of statins for this indication cannot be made with the available data. Randomized controlled trials are certainly needed to determine the association between statins and decreased mortality risk from esophageal cancer.

REFERENCES

    1. Shaheen NJ,
    2. Falk GW,
    3. Iyer PG,
    4. Gerson LB; American College of Gastroenterology
    . ACG Clinical Guideline: diagnosis and management of Barrett’s esophagus. Am J Gastroenterol 2016; 111(1):30–50. doi:10.1038/ajg.2015.322
    1. American Gastroenterological Association;
    2. Spechler SJ,
    3. Sharma P,
    4. Souza RF,
    5. Inadomi JM,
    6. Shaheen NJ
    . American Gastroenterological Association medical position statement on the management of Barrett’s esophagus. Gastroenterology 2011; 140(3):1084–1091. doi:10.1053/j.gastro.2011.01.030
    1. Nguyen T,
    2. Khan A,
    3. Liu Y,
    4. El-Serag HB,
    5. Thrift AP
    . The association between statin use after diagnosis and mortality risk in patients with esophageal cancer: a retrospective cohort study of United States veterans. Am J Gastroenterol 2018; 113(9):1310–1318. doi:10.1038/s41395-018-0169-6