Barrett’s esophagus: Diagnosis and management

Abstract

Barrett’s esophagus (BE) is a premalignant lesion in the esophagus that carries a risk of transforming into esophageal adenocarcinoma (EAC). It is believed that virtually all EACs arise from BE. The incidence of BE appears to have increased over the last four decades for unclear reasons. Risk factors for BE include chronic gastroesophageal reflux, old age, male gender, obesity, and tobacco use; the majority of BE cases occur in males and approximately 1–5% of the population is affected. Individuals with BE are monitored on a regular basis with endoscopic and esophageal biopsies to assess for evidence of histologic progression defined by the presence of dysplasia. Those individuals with high-grade dysplasia and early EAC are now treated with endoscopic procedures, including endomucosal resection and radiofrequency ablation. Advances are being made in the area of BE and EAC molecular markers to improve the ability to diagnose and manage BE and EAC as well as in potential chemoprevention therapies. The current management and evolving areas with regards to the prevention, detection, monitoring, and management of BE will be discussed.