Barrett's esophagus, special aspects: Surgical therapy

The indication for antireflux procedures in patients with Barrett's esophagus is discussed controversially. The indication for surgery should be based on the criteria of the underlying gastroesophageal reflux disease. The complexity of the pathophysiologic functional defects in Barrett's patients, e.g., the decreased sensibility of the columnar lined epithelium for pain when reflux occurs as well as the potential risk for carcinogenesis are special issues that must be kept in mind. The presence of specialized columnar epithelium with intestinal metaplasy together with documented gastroesophageal and duodenogastroeesophageal reflux should be an additional, but not the only argument for indication for surgery in gastroesophageal reflux disease.