The rising incidence of Barrett’s esophagus (BE) over the past two decades, coincident with increases in obesity, chronic heartburn, and gastroesophageal reflux disease, has focused attention on questions about how to monitor and treat these patients. About four in 1,000 BE patients annually develop esophageal adenocarcinoma (EAC), a 30- to 40-fold greater risk than in the general public. EAC, in turn, is linked to five-year survival rates of only about 20 percent. While early identification of high-risk BE patients is critical to improve EAC survival, factors predictive of cancer progression have not been identified.
“We really don’t understand yet why some patients with BE progress to develop esophageal dysplasia and EAC, while most others don’t. The research we’re beginning to conduct at Penn State Hershey Medical Center aims to identify molecular red flags in BE patients that predict EAC,” says Douglas Stairs, Ph.D. Stairs, along with colleagues at Penn State Hershey Gastroenterology and Hepatology, including Thomas J. McGarrity, M.D., and Atul Bhardwaj, M.D. recently launched efforts to build a BE tissue bank, using blood and tissue samples obtained from routine endoscopic monitoring in Medical Center BE patients. “We expect to enroll about 150 patients in the tissue bank project in this first year; each time a participant undergoes endoscopy, additional samples will be obtained. The tissue bank will allow us to conduct prospective, longitudinal, population analyses of gene expression patterns in patients with BE,” explains Stairs.
An over-arching goal of the BE tissue bank research program is to identify biomarkers that predict short- and long-term clinical outcomes. Stairs adds, “In the short-term, we plan to look for biomarkers associated with esophageal dysplasia and presence of EAC. After several years, different research questions will be examined. With years of follow-up data for individual patients, we plan to identify gene expression patterns that predict a positive response to treatment.”
A longer-term goal is to develop a blood test that will allow stratification of BE patients upon diagnosis into low versus high EAC risk groups. Theoretically, high-EAC risk patients may undergo closer monitoring and more aggressive treatment, and low-EAC risk patients relatively less frequent monitoring and more conservative treatment. Looking to the future, BE biomarker data may help to make early EAC identification and improved survival a routine event.
Douglas B. Stairs, Ph.D.
Assistant Professor of Pathology and Pharmacology
Department of Pathology, Department of Pharmacology
Penn State Hershey Cancer Institute
MEDICAL SCHOOL: University of Pennsylvania (Ph.D.)