Highlights from this issue
What is the incidence of oesophageal adenocarcinoma in non-dysplastic Barrett's?
The most widely cited annual incidence of oesophageal adenocarcinoma (OAC) in Barrett's oesophagus (BO) is 0.5% but this estimate did not account for the presence of baseline dysplasia. In this issue of Gut, Desai et al report an updated meta-analysis of observational studies and provide an accurate estimate of the risk of OAC in patients with BO who were free of dysplasia at baseline. The 57 included studies comprised 11 434 patients and 58 547 patient-years of follow-up. The pooled annual incidence of OAC was 0.33% (95% CI 0.28% to 0.38%). During surveillance, patients with non-dysplastic BO may be at least 10 times more likely to die from an unrelated cause than to develop OAC. Among 16 studies that provided information on patients with short-segment BO, the annual incidence of OAC was only 0.19%. The incidence of OAC in non-dysplastic BO is around 1 per 300 patients per year while that in short-segment BO is under 1 per 500 patients per year. These estimates are much lower than previously thought and suggest that surveillance strategies for patients with non-dysplastic BO, particularly those with short segments, may need to be reconsidered (see page 970).
Microbial fingerprinting and IBS subtypes
Irritable bowel syndrome (IBS) onset may follow enteric infections. The gut microbiota is emerging as a key determinant of colonic health and …