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Barrett`s esophagus (BE) is a condition in which the esophageal mucosa is replaced by intestinal mucosa (columnar metaplasia of the esophagus) and occurs as a complication of chronic gastroesophageal reflux disease (GERD). The prevalence of BE in the general population has been estimated at 1% but the disease is asymptomatic in up to 90% of patients. The high-grade form is much less common with an estimated prevalence of around 1 in 3000. BE is about twice as common in men as in women and is much more common in Whites and Hispanics compared to Blacks and Asians. BE can be found at any age but the prevalence increases with advancing age (average age at diagnosis is 60). Approximately 10-15% of GERD patients develop BE. Other risk factors include tobacco use and obesity. Patients with BE have the symptoms of GERD, usually more severe: heartburn, regurgitation of fluid, nausea, trouble swallowing, loss of appetite, weight loss, esophageal peptic ulcers and stricture. The inflamed esophagus can cause slow bleeding leading to anemia. Massive gastrointestinal bleeding is rare. The exact etiology remains unknown. The same factors that cause GERD are thought to cause BE. BE is diagnosed by upper gastrointestinal endoscopy and histological analysis of biopsied tissue. Repeated and long-term exposure of the esophagus to stomach acid leads to metaplasia that can progress to dysplasia, ultimately leading to carcinoma. Patients with BE have a 30 to125-fold higher risk of developing esophageal cancer than the general population. Management aims at decreasing gastroesophageal reflux, improving esophageal clearance, and preventing the development of esophageal cancer. Combination of diet, lifestyle changes, medication and surgery are used. Large and high-fat meals and eating within three hours of going to bed should be avoided. Chocolate, nicotine, peppermint, raw onions, caffeine and alcohol aggravate reflux. Medications include antisecretory drugs (proton pump inhibitors, H-2-receptor blockers) and prokinetics. Surgical (open or laparoscopic) fundoplication offers an alternative to medication. Esophagectomy is a standard therapy for high grade dysplasia and cancer. Photodynamic therapy, electrocautery, laser therapy and argon plasma coagulation are under evaluation. In 2004, porfimer sodium obtained EU marketing authorization as an Orphan drug for treatment of high-grade dysplasia in BE. Patients with BE require regular monitoring with surveillance endoscopy. |