Der Gastroenterologe

, Volume 8, Issue 6, pp 487–494 | Cite as

Barrett-Ösophagus

Indikatoren für die Karzinomentwicklung
Schwerpunkt
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Zusammenfassung

Der Barrett-Ösophagus (BÖ) als Komplikation einer chronischen gastroösophagealen Refluxerkrankung (GERD) stellt die präkanzeröse Kondition für das Adenokarzinom des distalen Ösophagus dar. Das sog. Barrett-Karzinom zeigt in der westlichen Hemisphäre eine deutliche Inzidenzsteigerung, die allerdings nicht ganz so dramatisch ist wie früher angenommen. Der wichtigste Risikofaktor für die Karzinomentstehung ist der Nachweis von dysplastischen Epithelveränderungen im BÖ, wobei neuerdings eine Subklassifizierung der Dysplasie in einen häufigeren adenomatösen („intestinalen“) und einen nichtadenomatösen („gastral-foveolären“) Typ etabliert wird. Goldstandard für die Dysplasiediagnose ist nach wie vor die HE-Färbung. Aktuelle Daten zeigen jedoch, dass bei Verwendung von endoskopischen Resektaten anstatt von Biopsien die Interobservervariabilität deutlich geringer ist als in Biopsieuntersuchungen. Aufgrund der weitreichenden klinischen Konsequenzen sollte obligat eine Zweitbeurteilung jeder Dysplasiediagnose erfolgen. Aus der Vielzahl der untersuchten Biomarker für ein erhöhtes Progressionsrisiko zum Karzinom haben sich bislang lediglich der durchflusszytometrisch bestimmte DNA-Gehalt und p53-Mutationen bzw. LOH von Chromosom 17p als konsistente Risikoprädiktoren in Phase-4-Studien erwiesen. Für die Etablierung weiterer, z. T. vielversprechender Marker sind prospektive klinische Studien erforderlich. Insgesamt erweisen sich dabei offenbar Markerpanels gegenüber Einzelmarkern als überlegen.

Schlüsselwörter

Gastroösophageale Refluxerkrankung Intestinale Metaplasie Dysplasie Adenokarzinom des Ösophagus Biopsie 

Abkürzungen

Barrett-Ösophagus

GERD

Gastroösophageale Refluxerkrankung

ERDN

Early Detection Research Network

LGD/LGIEN

Niedriggradige Dysplasie bzw. intraepitheliale Neoplasie

HGD/HGIEN

Hochgradige Dysplasie bzw. intraepitheliale Neoplasie

Barrett’s esophagus

Indicators for cancer progression

Abstract

Barrett’s esophagus (BE), a well-known complication of gastro-esophageal reflux (GERD), constitutes a precancerous condition for adenocarcinoma of the distal esophagus. Barrett’s carcinoma shows increasing incidences in countries of the western hemisphere; new data, however, indicate that the rise in incidence is not quite as dramatic as previously assumed. Dysplastic changes in Barrett’s epithelium are considered the most important risk factor for the development of Barrett’s adenocarcinoma; recently, dysplasia was subclassified into a more frequent adenomatous (intestinal) and a non-adenomatous (gastric-foveolar) type. H&E staining still is the gold standard for diagnosing dysplasia. Current data show better interobserver agreement in endoscopical resection specimens than in biopsies. Nevertheless, the histological diagnosis of Barrett’s dysplasia should be corroborated by a second opinion because of its clinical consequences. Even though a multitude of biomarkers for increased risk of progression to cancer has been investigated, only DNA content (flow cytometry) and mutations/LOH of chromosome 17p have been proven as consistent markers of increased risk of progression to cancer. Further prospective clinical trials are needed to establish other indicators of progression, marker panels appear to be of better use than single markers.

Keywords

Gastroesophageal reflux disease Barrett metaplasia Dysplasia Adenocarcinoma of esophagus Biopsy 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Institut für PathologieUniversitätsklinikum „Carl Gustav Carus“, TU DresdenDresdenDeutschland

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