The relationship between gastroesophageal reflux, intestinal metaplasia and adenocarcinoma of the esophagus

Currently available data indicate a clear and probably causal relationship between long-lasting gastroesophageal reflux disease, the development of lo ng segments with specialized intestinal metaplasia in the distal esophagus and subsequent progression to adenocarcinoma. To a lesser degree, this also appears to be the case for short segments of specialized intestinal metapl asia in the distal esophagus. In contrast, epidemiological data and classic parameters for the diagnosis of gastroesophageal reflux disease do not cur rently support a causal role of gastroesophageal reflux in the pathogenesis of specialized intestinal metaplasia at the gastric cardia. Despite its hi gh prevalence and malignant potential, many questions about the prevention and management of intestinal metaplasia in the distal esophagus remain unso lved. In patients with chronic gastroesophageal reflux, current modes of me dical therapy do not appear to prevent the development of intestinal metapl asia, while effective anti-reflux surgery seems to have a protective effect . Formal studies with adequate follow-up are, however? still lacking. Neith er acid-suppression therapy nor anti-reflux surgery, with or without mucosa l ablation, can reliably prevent the malignant degeneration of established intestinal metaplasia of the esophagus. Close endoscopic surveillance with extensive biopsies, therefore, remains mandatory in such patients, irrespec tive of the treatment modality.