Barrett's Esophagus

Abstract

Barrett's esophagus (BE) is a precancerous condition marked by the replacement of the normal stratified squamous epithelium in the distal esophagus with metaplastic columnar epithelium, typically resulting from chronic gastroesophageal reflux disease (GERD). This pathological adaptation significantly increases the risk of developing esophageal adenocarcinoma (EAC), a malignancy with rising incidence, particularly in Western populations. This review provides a comprehensive overview of the current understanding and management of BE, drawing on major international guidelines and recent advancements. We examine the underlying pathophysiology, including metaplastic transformation and molecular alterations that contribute to neoplastic progression. Risk factors such as GERD, age, sex, obesity, and smoking are discussed, alongside their role in disease development. Diagnostic protocols, including endoscopic visualization, histologic grading, and advanced imaging techniques, are outlined with an emphasis on early detection. The review compares management strategies across established guidelines from organizations such as AGA, ESGE, and BSG, including medical, endoscopic, and surgical approaches. Surveillance recommendations and real-world adherence are critically assessed, highlighting common barriers to effective monitoring. Additionally, we explore emerging diagnostic and therapeutic innovations such as artificial intelligence-enhanced imaging, tissue-based and liquid biopsies, and personalized treatment models. Finally, the paper discusses future directions aimed at improving early diagnosis, enhancing risk stratification, and reducing progression to EAC. By integrating current evidence and technological advances, this review underscores the need for personalized, guideline-adherent care to optimize outcomes for patients with BE.

Keywords: Barrett's esophagus; endoscopic surveillance; esophageal adenocarcinoma; gastroesophageal reflux disease; risk stratification.