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Barrett’s esophagus and new therapeutic modalities

Virender K Sharma and David E Fleischer

Barrett’s esophagus is a metaplastic change of the epithelium of the esophagus, caused by injury and inflammation related to gastroesophageal reflux disease. Metaplasia is defined as the transformation from one cell type to another cell type. In the case of Barrett’s esophagus, the normal squamous epithelium is replaced by a columnar epithelium-containing goblet cells, deemed intestinal metaplasia (IM). Owing to a significantly elevated risk for the development of esophageal adenocarcinoma associated with the presence of IM, patients with this diagnosis undergo surveillance endoscopy with multiple biopsies of the diseased tissue every 2–3 years, in order to detect adenocarcinoma at the earliest possible tumor stage. Development of dysplastic cellular changes within the Barrett’s epithelium often precedes the development of cancer. In cases of IM containing dysplasia, surveillance endoscopy is performed more frequently (every 3–12 months). For many patients with high-grade dysplasia, the esophagus may be removed surgically in order to preempt the development of cancer.