Management of Barrett’s Esophagus
There have been major recent advances in the understanding of the pathogenesis and epidemiology of Barrett’s esophagus and adenocarcinoma of the esophagus. The advent of potent acid suppression with proton pump inhibitors and safe, minimally invasive antireflux procedures has made alleviating sympto...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2000-01-01
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| Series: | Canadian Journal of Gastroenterology |
| Online Access: | http://dx.doi.org/10.1155/2000/319616 |
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| Summary: | There have been major recent advances in the understanding of the
pathogenesis and epidemiology of Barrett’s esophagus and adenocarcinoma
of the esophagus. The advent of potent acid suppression
with proton pump inhibitors and safe, minimally invasive antireflux
procedures has made alleviating symptoms and eliminating peptic
complications achievable goals for the vast majority of patients. Endoscopic
surveillance of Barrett’s esophagus is considered the standard
of care and is widely used in clinical practice. Neither medical
nor surgical antireflux procedures, however, result in the regression
of Barrett’s esophagus in any consistent manner. Thermal and
chemical endoscopic ablation techniques show promise in both the
management of high grade dysplasia and the reversal of Barrett’s
esophagus, but these techniques are still of unproven benefit, and
can be costly and risky. Therefore, prospective and controlled studies
with long term follow-up are needed before incorporating ablative
techniques into routine clinical practice. Management of high
grade dysplasia remains controversial. Alternative management
strategies include surveillance, resection or ablation, tailored to the
individual patient and the available expertise. Targets for future research
include defining appropriate surveillance intervals; finding
biological markers that identify patients at higher risk of progressing
to cancer; defining the cancer risk and the appropriate management
of patients with short segment Barrett’s esophagus; understanding
the natural history of dysplasia and comparing alternatives for the
management of high grade dysplasia; and studying whether surgical
management can delay or prevent the progression to dysplasia and
adenocarcinoma. |
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| ISSN: | 0835-7900 |