From chronic reflux to oncological risk: new molecular analyzes and artificial intelligence change the prevention of esophageal adenocarcinoma.
In recent years the cancer of the esophagus is showing a growing trend in Western countriesespecially in its most widespread form, adenocarcinoma, closely linked to gastroesophageal reflux andBarrett’s esophagus. In Italy they are registered approximately every year 2,300-2,500 new diagnoseswith a clear prevalence in men. What worries specialists is not only the incidence, but also the mortality still high and the diagnosis is often late. A framework that makes the prevention and monitoring of precancerous conditions. Condition linked to gastroesophageal reflux, theBarrett’s esophagus requires lifelong endoscopic checks. New today molecular technologiessupported by artificial intelligence, allow the risk of tumor evolution to be stratified more precisely. He explains it to us Professor Emanuele Asti, director of the new Esophagus and Reflux Center (CER) of the IRCCS Policlinico San Donato, where he is also responsible for the General and Emergency Surgery Unit. To defend itself from the acidity caused by chronic reflux, the esophagus tries to protect itself by replacing the tissue that lines it with one similar to that of the intestine, which is more resistant. This process, called intestinal metaplasia, represents an adaptive response of the organism. However, it is not without consequences: in reprogramming their genetic code, esophageal cells can make mistakes that, over time, can lead to a adenocarcinoma of the esophagus. “THE’Barrett’s esophagus represents the main precancerous condition of the esophagus. The risk of it evolving into cancer is relatively low each year, estimated at between 0.1% and 0.5%, but over the course of a lifetime it can reach between 3% and 13%. In patients with chronic gastroesophageal reflux the risk increases further, reaching 8-15%. Furthermore, explains Asti, the probability of progression increases if the disease has been present for more than ten years and is higher in the years men over 50especially if you smoke or are overweight.”
New hopes from advanced molecular analysis
In recent years, research is profoundly changing the management of this condition. If in the past the analysis was limited to evaluating the architecture of the cells under the optical microscope to establish the presence and degree of dysplasiatoday it is possible to directly study i molecular mechanisms that guide the evolution of the disease.
«One of the most advanced innovations of our Center» explains the professor «is the possibility for patients to access aadvanced molecular analysiscurrently not available in Europe. This technology integrates theartificial intelligence with the study of nine protein biomarkers (spatialomics)allowing a much more precise stratification of the risk of tumor evolution.” The added value of the new diagnostic frontier lies in the ability to unmask the so-called “silent progressors”those who, subjected to traditional biopsyreceive an apparently reassuring report, but which hides a very different reality.
The patient registry and personalized prevention
To further improve clinical management a Barrett’s esophagus registrywhich allows you to customize your risk profile. In addition to the endoscopic aspect, in fact, the developmental risk also varies based on lifestyle and other clinical factors. Through aintegrated analysis it is possible to establish a risk level and schedule checks with a personalized cadence. “The objective is to make surveillance more targeted, with an advantage for patients but also for the sustainability of the system.”
It is essential to consult a specialist
It is important to avoid theself-management of refluxoften favored by misleading advertising messages. «The treatment of reflux cannot be improvised – concludes Professor Asti -. It is essential to contact high volume centers able to correctly evaluate the risk of disease evolution and set adequate prevention strategies». The cancer of the esophagusIn fact, it is increasing in Western countries. In Italy, last year, there were approximately 2,500 new cases. Specialist management of the disease can make the difference, especially when early diagnosis and technological innovation are integrated into one structured clinical path.
