Optimizing Patient Outcomes through Early Detection of Uncontrolled Acid Reflux after Endoscopic Therapy for Pre-Cancerous Lesions in the setting of Barrett’s Esophagus

Barrett’s Esophagus (BE) is a precursor for esophageal adenocarcinoma, a deadly cancer whose frequency has increased by a factor of more than 7 in the past four decades and whose five-year survival rate remains around 20%. Patients are treated medically using acid blocking and require surveillance endoscopy to ensure the lesions do not progress to cancer. Patients with more advanced forms of the disease are treated with endoscopic treatments. Once patients have been successfully treated using endoscopic therapy, they must continue to have regularly scheduled endoscopies with biopsies to ensure the abnormal, precancerous, tissue does not return. Previous studies in patients without endoscopically treated BE have demonstrated consistent changes in the esophageal lining on biopsy samples that are indicative of uncontrolled acid reflux. Similarly, such markers may be present in patients with BE after endoscopic therapy and could allow for early detection of uncontrolled reflux, the etiology of disease recurrence. We will use existing biopsy samples from 65 patients who have successfully completed endoscopic treatment for pre-cancerous esophageal changes in the setting of BE and have undergone 24-hr transnasal catheter pH testing for reflux. Specific Aim 1: To analyze esophageal biopsy samples in patients with BE before and after endoscopic treatment to assess for changes in the tissue architecture suggestive of uncontrolled reflux. Specific Aim 2: To demonstrate the ability of esophageal tissue markers of reflux in BE to successfully identify patients with persistent reflux on direct testing. This will allow for an evaluation of the effectiveness of tissue samples to serve as a surrogate to invasive reflux testing.