Barrett's Esophagus

Question 1

what are 2 independent risk factors for esophageal adenocarcinoma?

Answer 1

laryngopharyngeal reflux sxs

chronic cough

Question 2

what dz increases a person’s risk for BE? what 3 lifestyle factors? the use of what rx could possibly decrease risk of EAC in BE pts?

Answer 2

dz: T2 DM
lifestyle factors: smoking, increasing BMI, alcohol consumption
risk of EAC in BE pts could be decreased by statin use

Question 3

4 key objectives to tx pts w/BE?

Answer 3

control or correct reflux
prevent dysplasia in areas of metaplasia
increase differentiation of epithelium
promote healing of esophagitis

Question 4

what diet modification could decrease risk of BE in men and women?

Answer 4

increase veggies and fruit

Question 5

what acid could help prevent DNA damage, cytotoxicity and ROS and help to prevent dysplasia/EAC in pts w/BE?

Answer 5

cytoprotective hydrophilic bile aicd glycoursodeoxycholic acid

Question 6

in relation to preventing dysplasia/EAC what are the 2 effects of PGE2 series? 3 effects of COX2?

Answer 6

PGE2: increase angiogenesis and cell proliferation
decrease immune surveillance
COX2: decreases apoptosis
increases invasiveness of malignant cells
increases ROS

Question 7

what is the effect of polyphenon E (a GT extract)?

Answer 7

inhibits growth of transformed epithelial cells

Question 8

what is the effect of retinoids in BE epithelial cells?

Answer 8

increase apoptosis in BE epithelial cells which may provide chemoprotection

Question 9

effect of selenium on abn cells?

4 specific things it can decrease?

Answer 9

has been found to slow abn cell growth, prevent DNA damage and facilitate apoptosis

1. dysplasia
2. inactivation of tumor suppressor gene p53
3. aneuploidy
4. increased 4N fraction

Question 10

what is the effect of curcuma longa?

Answer 10

downregulates COX-2, LOX, synthesis of PGE2

inhibits NF-kB in EAC: promotes apoptosis, increases sensitivity to chemotherapeutic agents

Question 11

in summation, in order to prevent dysplasia and EAC in BE pts, what things do you need to do? (txs, diet, lifestyle, supplements, etc)

Answer 11

treat the cause of ongoing GERD
get off PPIs if they're on them
increase fruits and veggies
tx SIBO if present to prevent excess deconjugation of bile salts
use berry extract and/or retinoids
curcumin or other herbal COX-2 inhibitors
selenium
green tea catechins
ursodeoxycholic acid