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From Heartburn to Barrett’s Esophagus, and Beyond

  • Surgical Symposium Contribution
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Abstract

Background

Gastroesophageal reflux disease (GERD) affects an estimated 20% of the population in the USA, and its prevalence is increasing worldwide. About 10–15% of patients with GERD will develop Barrett’s esophagus (BE).

Aims

The aims of this study were to review the available evidence of the pathophysiology of BE and the role of anti-reflux surgery in the treatment of this disease.

Results

The transformation of the squamous epithelium into columnar epithelium with goblet cells is due to the chronic injury produced by repeated reflux episodes. It involves genetic mutations that in some patients may lead to high-grade dysplasia and cancer. There is no strong evidence that anti-reflux surgery is associated with resolution or improvement in BE, and its indications should be the same as for other GERD patients without BE.

Conclusions

Patients with BE without dysplasia require endoscopic surveillance, while those with low- or high-grade dysplasia should have consideration of endoscopic eradication therapy followed by surveillance. New endoscopic treatment modalities are being developed, which hold the promise to improve the management of patients with BE.

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Authors and Affiliations

  1. Department of Surgery, Center for Esophageal Diseases and Swallowing, University of North Carolina, Chapel Hill, NC, USA

    Francisco Schlottmann & Marco G. Patti

  2. Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, CB#7080, Chapel Hill, NC, 27599-7080, USA

    Marco G. Patti & Nicholas J. Shaheen

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  1. Francisco Schlottmann
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Correspondence to Nicholas J. Shaheen.

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Schlottmann, F., Patti, M.G. & Shaheen, N.J. From Heartburn to Barrett’s Esophagus, and Beyond. World J Surg 41, 1698–1704 (2017). https://doi.org/10.1007/s00268-017-3957-z

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