Barrett’s Esophagus, Colorectal Adenomas and Carcinomas - What’s the Connection? Reply to Vieth & Stolte

I thank Drs Vieth and Stolte for their report of another patient with Barrett’s disease and an adenomatous colorectal polyposis syndrome. I suspect many investigators around the world are also looking for a connection between the dysplasia-carcinoma sequences of Barrett’s esophagus and colorectal adenomas [1]. Such a connection may be related to cytogenetic abnormalities, such as the loss of heterozygosity at tumor suppressor genes (DCC, APC, TP16 and TP53) found in both diseases [2]. Other investigators have studied clinical factors, such as the decreased use of aspirin or cyclooxygenase-2 inhibitors in patients with esophageal and colonic neoplasms [3] [4] [5] [6] [7]. Perhaps of most concern are the pleiomorphic changes observed in Barrett’s glandular mucosa induced by hypergastrinemia in patients treated chronically with acid suppressive drugs [8] [9] [10] [11] [12]. Investigations into the association of Barrett’s disease with adenomatous colon polyposis syndromes, including genomic studies, may yield important clues regarding germ-line and somatic cell abnormalities and the variability in genotype-phenotype correlations, the effect of modifying genes, and the contribution of environmental influences [13] [14].

References

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