The role of secondary versus tertiary prevention in decreasing the incidence of esophageal adenocarcinoma in patients with barrett’s esophagus

A project presented to the Department of Physician Assistant of Wichita State University in partial fulfillment of the requirements for the degree of Master of Physician Assistant.The rapidly increasing incidence and high mortality of esophageal adenocarcinoma necessitate the need for research to determine the most effective method of prevention. Barrett’s Esophagus is a premalignant condition of esophageal adenocarcinoma. The objective of this study is to determine if secondary or tertiary prevention is more effective in decreasing the incidence and mortality in Barrett’s esophagus and esophageal adenocarcinoma. Methods: This study is an evidence based literature review. Key words used included gastroesophageal reflux disease, Barrett’s esophagus, esophageal neoplasm, and treatment. Results: The literature revealed that the main method of secondary prevention is through screening and surveillance with much controversy regarding the use of these methods. Controversial issues include the success of early detection in modification of the course of the disease, guidelines for surveillance, and cost-effectiveness. Forms of tertiary prevention include proton pump inhibitors, COX II inhibitors, endoscopic procedures and open antireflux surgeries. There is evidence for and against all secondary and tertiary prevention methods resulting in controversy regarding the effectiveness of all therapies in preventing incidence and mortality of the disease. Conclusions: Research on prevention of Barrett’s esophagus and esophageal adenocarcinoma is highly debated and provides varied results. There is no clear answer on which method of prevention will decrease the overall incidence or mortality of the disease, though some of the therapies with supporting evidence should not be withheld due to the high mortality involved. This subject requires additional research including prospective randomized trials