Role of p53 Assessment in Management of Barrett's Esophagus

The risk of developing gastroesophagealadenocarcinoma is increased in patients with Barrett'sesophagus. The management of dysplasia in Barrett'sesophagus remains controversial. Understanding of thesequence of events preceding malignancy is essentialbefore screening protocols for early diagnosis andpreventive measures can be implemented. The aim of thisreview is to examine the published data on the role p53 assessment may play in the management ofBarrett's esophagus. Relevant papers were identified byan extensive text word search of the Medline databaseand a review of quoted articles. The p53 abnormality occurs more frequently in highly dysplasticepithelium than in nondysplastic epithelium. However,the retrospective nature of most of the available datacould be a significant confounding factor. Our current knowledge suggests that p53 proteinoverexpression does not seem to predict futureprogression to cancer or determine disease outcome. Thep53 abnormality alone can not be reliably used topredict progression of Barrett's esophagus to cancer. We must awaitlong-term evaluation of patients to determine thepercentage of patients with p53 gene abnormality, andnondysplastic Barrett's who will progress to dysplasia or carcinoma. Large randomized controlledlong-term follow-up studies are much needed.