Barrett esophagus

Abstract

A number of publications have provided valuable insight into and data on the epidemiology, pathogenesis, diagnosis, risk factor evaluation, and treatment of patients with Barrett esophagus. Although the incidence of esophageal adenocarcinoma has rapidly increased over the past two decades, it is not clear whether there has been a parallel increase in the frequency of Barrett esophagus. The issue of surveillance endoscopy in patients with Barrett esophagus remains controversial; prospective data are still lacking. Bile reflux plays an important role in the pathogenesis of Barrett esophagus; however, this usually occurs in the presence of acid. Newer technology and techniques, including chromoendoscopy, magnification endoscopy, optical coherence tomography, and spectroscopy, have opened the field by providing a more accurate and "nonbiopsy" diagnosis of intestinal metaplasia and dysplasia. The field of biomarkers remains continues to expand and is providing insight into risk stratification of patients with Barrett esophagus. The exact role of acid suppression in patients with this premalignant disease remains controversial, and endoscopic therapies appear promising.