What is the optimal medical therapy for Barrett's esophagus?

The development of Barrett's esophagus (BE) in patients with gastroesophage al reflux disease (GERD) is troubling because of its known association with esophageal cancer. When evaluated clinically, patients with BE have the se verest form of GERD and require aggressive therapy to control esophageal ac id exposure. Both hypotension of the lower esophageal sphincter and the ext ent of esophageal acid exposure are major contributors to severe GERD and i ts complications. It is hypothesized that better control of acid will impro ve outcomes for BE patients. While it is clear that therapy (medical or sur gical) for reflux rarely if ever results in total regression of BE, there a re some limited data to support improvement in BE with control of reflux. C urrent medical choices include prokinetic agents, histamine type-2 receptor antagonists, and proton pump inhibitors. In the future, genetic markers ma y be used in identifying BE patients at the greatest risk for histologic pr ogression, and chemoprevention with cyclooxygenase-2 inhibitors may be a th erapeutic option. This paper will review the rationale for and results of m edical antireflux therapy in patients with BE. Copyright (C) 2001 S. Karger AG, Basel