Medical therapy versus antireflux surgery in Barrett's esophagus: What is the best therapeutic approach?

We conducted a review of the literature comparing medical treatment with an tireflux surgery in patients with Barrett's esophagus (BE), In particular, we wanted to assess the efficacy of medical and surgical therapies in preve nting the progression of Barrett's epithelium to dysplasia or adenocarcinom a of the esophagus. In general, few BE patients show complete regression of BE epithelium following medical or surgical therapy. The incidence of deve loping dysplasia or cancer following surgical therapy appears to be less th an with medical therapy; however, there is an insufficient number of curren t, randomized controlled studies to confirm this. Surveillance of BE is req uired regardless of treatment. This review suggests that there may be a tre nd in support of surgery being somewhat better than medical therapy in the prevention of BE progression and adenocarcinoma. We suggest that patients w ith BE should be considered for antireflux surgery - in particular, certain subgroups of BE patients. Copyright (C) 2001 S.Karger AG, Basel