Patients with Barrett's esophagus where squamous esophageal epithelium
has been replaced by columnar epithelium containing goblet cells have
an increased risk of esophageal adenocarcinoma. Unfortunately, most o
f those adenocarcinomas are detected at an advanced stage in which the
y are incurable. Many biomarkers have been studied, trying to identify
the subset of patients who are at very high risk for adenocarcinoma.
Dysplasia is at present the 'golden standard' for the risk of adenocar
cinoma. However, over-expression of p53. allelic losses, proliferation
indices, flow cytometric abnormalities, accumulation of acidic fibrob
last growth factor, expression of blood group antigens and sucrase-iso
maltase during the Barrett's to adenocarcinoma sequence appear promisi
ng. However. additional information is needed to justify routine appli
cation in clinical practice and in define their role in surveillance p
rograms.