Reflux disease and Barrett's esophagus

Gastroesophageal reflux disease (GERD) is a common clinical problem. New in formation suggests that infection with Helicobacter pylori may protect pati ents from developing GERD and its complications. Endoscopy may be used by c linicians to tailor GERD therapy, but an empirical trial of a proton-pump i nhibitor may be an alternative diagnostic approach. Studies continue to sho w that laparoscopic antireflux surgery is a cost-effective treatment option for patients requiring maintenance therapy with proton-pump inhibitors. Ho wever, the minimally invasive nature of the operation should not alter the indications for antireflex surgery, especially for patients with atypical s ymptoms. It remains unclear why some patients with GERD develop Barrett's esophagus, whereas others do not. Recent guidelines suggest that patients with long-s tanding GERD symptoms, especially white men over 50 years of age, should un dergo endoscopy at least once to screen for Barrett's esophagus, Debate con cerning short-segment Barrett's esophagus continues. Intestinal metaplasia at a normal-appearing gastroesophageal junction may be associated with inte stinal metaplasia of the stomach and infection with H, pylori, whereas shor t tongues of intestinal metaplasia in the esophagus are associated with GER D, Cancer surveillance is indicated in short-segment Barrett's esophagus, a s dysplasia may develop in these patients. Barrett's esophagus is the only known risk factor for the development of esophageal adenocarcinoma, but the incidence of adenocarcinoma may be lower than previously reported. New clinical guidelines for endoscopic surveillance suggest that the survei llance interval should be lengthened to every two years in patients without dysplasia, Newer treatment options, such as thermal ablation and photodyna mic therapy, continue to show promise, but are not yet ready for routine cl inical use.