Barrett’s Esophagus

Barrett’s esophagus (BE) is a condition that develops when esophageal squamous mucosa, damaged by the chronic gastroesophageal reflux of acid and bile, is replaced by a metaplastic columnar mucosa that has both gastric and intestinal features. This chapter reviews the pathogenesis of BE, its diagnostic criteria, the basis of its malignant predisposition, management recommendations, treatment strategies, and ongoing controversies. BE is diagnosed predominantly in older white men in developed countries. Cancers can develop much more rapidly through the genome-doubled pathway than through the traditional pathway, a feature that might explain the frequent failure of endoscopic surveillance to detect cancer progression in BE. BE management now involves many evolving techniques-from better ways to screen and identify patients at risk to more advanced techniques for treating and following the post-endoscopic eradication therapy esophagus.