Barrett's esophagus

Barrett's esophagus is the condition in which a metaplastic columnar mucosa that predisposes to cancer development replaces the stratified squamous mucosa that normally lines the distal esophagus. The condition develops as a complication of chronic gastroesophageal reflux disease (GERD), which is often severe in patients who have long segments of Barrett's metaplasia extending up the esophagus. Barrett's esophagus is a major risk factors for esophageal adenocarcinoma, a tumor whose frequency has increased more than six-fold over the past several decades. Because of this cancer risk, patients with Barrett's esophagus are advised to have regular endoscopic surveillance with esophageal biopsy sampling to detect dysplasia, the precursor of invasive adenocarcinoma. Until recently, patients with high-grade dysplasia in Barrett's esophagus were treated with esophagectomy. Today, most patients with high-grade dysplasia can be treated successfully with endoscopic eradication therapy. This chapter discusses the diagnosis, epidemiology, pathogenesis and management of Barrett's esophagus.