Although researchers have identified genetic alterations that contribute to development of esophageal adenocarcinoma, we know little about features of patients or environmental factors that mediate progression of chronic acid biliary reflux to Barrett’s esophagus and cancer. Increasing our understanding of the mechanisms by which normal squamous epithelium progresses to early-stage invasive cancer will help formulate rational surveillance guidelines and allow us to divest resources away from patients at low risk of malignancy. We review the cellular and genetic alterations that occur during progression of Barrett’s esophagus, based on findings from clinical studies and mouse models of disease. We review the features of the luminal and mucosal microenvironment of Barrett’s esophagus that promote, in a small proportion of patients, development of esophageal adenocarcinoma. Markers of clonal evolution can be used to determine patient risk for cancer and set surveillance intervals.

尽管研究人员已经发现了导致食管腺癌发展的基因改变，但我们对介导慢性酸性胆汁反流发展为巴雷特食管和癌症的患者特征或环境因素知之甚少。增加我们对正常鳞状上皮进展为早期浸润性癌症的机制的了解，将有助于制定合理的监测指南，并使我们能够从低恶性肿瘤风险患者身上剥离资源。我们根据临床研究和小鼠疾病模型的发现，回顾了巴雷特食管进展过程中发生的细胞和遗传改变。我们回顾了巴雷特食管的管腔和粘膜微环境的特征，这些微环境在一小部分患者中促进了食管腺癌的发展。克隆进化的标记可用于确定患者患癌症的风险并设定监测间隔。