Barrett Esophagus

Barrett esophagus is the condition in which normal stratified squamous epithelium of the esophagus is replaced by metaplastic columnar epithelium, which may predispose to development of malignancy. This metaplasia is thought to be a reparative mechanism to cope with reflex esophagitis induced by chronic gastroesophageal reflux disease. Barrett esophagus is associated with an increased risk of esophageal adenocarcinoma (EAC), although the more recent studies have shown that the risk of progression to malignancy is lower than was initially postulated. Endoscopic screening and surveillance are still warranted for early detection of dysplasia and neoplasia and prevention of EAC. This review looks at Barrett esophagus in detail, including its epidemiology and risk factors, etiology and pathogenesis, clinical presentation and symptoms, diagnosis, differential diagnosis, treatment, complications, and prognosis. Figures show images of Barret esophagus, endoscopic mucosal resection of nodule associated with Barrett esophagus, and focal radiofrequency ablation; a schematic of using Prague circumferential (C) and maximal extent (M) criteria to classify and report Barrett esophagus; and a proposed management algorithm for patients with Barrett esophagus. Tables list risk factors associated with Barrett esophagus and neoplastic progression to EAC, guidelines for screening and surveillance, and endoscopic eradication therapies. A list of useful Web sites relating to Barrett esophagus is also presented. This review contains ­5 highly rendered figures, 3 tables, and 33 references.