Barrett's Esophagus, a Complication of GERD

Abstract

The treatment of patients with Barrett's esophagus is similar to that of any patient with underlying gastroesophageal reflux disease (GERD). The treatment of reflux includes medical and surgical therapy. A key component of medical therapy is the use of a proton pump inhibitor to treat the underlying GERD. The major controversy is whether the end point of therapy should be the control of reflux symptoms or the control of esophageal pH. When controlling reflux symptoms with proton pump inhibitor therapy, it is important to eliminate all of the symptoms of reflux. An alternative to medical therapy is surgical fundoplication, which is currently performed laparoscopically. Fundoplication may be indicated when a patient has persistent regurgitation even while on proton pump inhibitor therapy. An individual patient also may choose fundoplication, preferring surgical intervention to taking medication long term on a daily basis. Patients with Barrett's esophagus also have the risk of the developing of adenocarcinoma of the esophagus. Therefore, there is an additional goal in the therapy for individuals with Barrett's to prevent progression to adenocarcinoma. The standard approach to the issue of the premalignant nature of Barrett's esophagus is surveillance endoscopy with biopsy in order to detect dysplasia, a cytologic and architectural histologic change. Dysplasia is the first step in the neoplastic process, an early stage offering the opportunity of intervention and longer-term survival.