Barrett's esophagus

Barrett's esophagus (BE) is the replacement of normal esophageal squamous cells by columnar cells. The diagnosis of BE requires both endoscopic identification of columnar epithelium in the distal esophagus and biopsy confirmation that the columnar lining is intestinal metaplasia with goblet cells. Cost-effectiveness models have shown that screening patients with chronic gastroesophageal reflux disease and other risk factors for BE compare favorably to other cancer screening strategies. Once BE is diagnosed, surveillance endoscopy is performed in an effort to detect dysplasia and esophageal adenocarcinoma (EAC) at a curable stage. Since acid reflux appears to contribute to both the development and neoplastic progression of BE, acid-suppressive medications have been proposed as chemopreventive agents. For patients with BE, proton pump inhibitor treatment to control acid reflux may reduce the risk of progression to dysplasia and EAC.