BARRETTS-ESOPHAGUS - UPDATE OF PATHOPHYSIOLOGY AND MANAGEMENT

Barrett's esophagus is a premalignant metaplastic change in the lining of the distal esophagus. It represents a peculiar form of healing whi ch occurs in response to chronic gastroesophageal reflux. The etiology of this condition is unknown but clinical and experimental data point s to esophageal exposure to duodenal juice as the key factor in its de velopment. Barrett's esophagus should be considered in all patients un dergoing endoscopy for symptoms of reflux disease. It is confirmed by the presence of intestinal metaplasia in an area of columnar mucosa, r egardless of the macroscopic appearances of the distal esophagus. Endo scopic surveillance with multiple biopsy of the columnar mucosa is ind icated for all medically fit patients with Barrett's esophagus. Identi fication of intestinal metaplasia with high-grade dysplasia heralds th e, development of invasive cancer and offers the physician an opportun ity to intervene. Esophagectomy is the treatment of choice for patient s with high-grade dysplasia, since occult early adenocarcinoma is iden tified in up to 50 percent of the esophageal specimens.