Barrett's esophagus is the major recognized risk factor for adenocarcinoma of the gastroesophageal junction, a tumor whose incidence has been increasing dramatically in the United States and Europe. Carcinogenesis in Barrett's esophagus involves genetic alterations that may activate protooncogenes and disable tumor suppressor genes. Unlike the colon, in which loss of chromosome 5q is an early event in carcinogenesis that usually precedes deletion of chromosome 17p, recent data suggest that 17p loss usually precedes 5q deletion during the development of adenocarcinoma in Barrett's epithelium. In an attempt to prevent these tumors, several groups of investigators have used laser irradiation to obliterate Barrett's epithelium. The irradiated mucosa heals with the regrowth of squamous epithelium, provided acid reflux is controlled by the administration of omeprazole. Further studies are necessary before laser photoablation of Barrett's epithelium can be recommended for widespread clinical application.
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