Risk Reduction and the GI Tract: From Theory to Reality

The concept of risk reduction with respect to diseases of the gastrointestinal tract encompasses problems that range from mucosal injury due to acid-related disorders and use of antiinflammatory medications to adenocarcinoma occurring anywhere from the esophagus to the rectum. The following articles provide clinicians with upto-date information about how to assess risk in individual patients and patient populations and about the options available to reduce risks for gastrointestinal diseases. Dr. Robert S. Sandler provides an insightful overview of the statistical approaches to the expression of risk and risk reduction and how these can convey different messages about the same degree of risk or effects of intervention. Dr. David J. Bjorkman continues the discussion of gastrointestinal risk with a review of issues and data related to the use of nonsteroidal antiinflammatory drug therapy. Barrett’s esophagus has an established association with esophageal cancer. Dr. Brian J. Reid discusses recent evidence for the processes involved in neoplastic transformation in Barrett’s metaplasia and the roles that interventions play, or might play, in preventing the development of esophageal cancer, including the role of proton pump inhibitors. Dr. Benjamin D. Gold lays out a compelling discussion that the increasing rate of reflux disease seen in adults might have its origin in childhood and where there is the possible opportunity for early intervention. Aspirin, nonsteroidal antiinflammatory drugs, and selective cyclooxygenase-2 inhibitors have shown promise as chemopreventive agents in experimental studies in animals and in large population studies of patients with colorectal polyps and cancer, as reviewed by Dr.C.Richard Boland. The role of Helicobacter pylori infection in gastric cancer is reviewed by Prof. Joseph J.Y. Sung. The data show a strong association between infection and increased cancer risk, but the potential value of H. pylori eradication therapy and when this should be undertaken remains to be demonstrated in ongoing clinical trials. I hope that physicians will find these articles informative and applicable to their clinical practice.