Medical and surgical evaluation of Barrett's esophagus and Barrett's cancer

Objective: This study reviews the development of Barrett's esophagus in patients with gastroesophageal reflux disease. Here we evaluate the progression of the disorder into esophageal adenocarcinoma in patients with Barrett's esophagus under treatment, and the effectiveness of current medical or surgical therapy regarding mucosal regression or progression. Methods: A MEDLINE search was performed to analyze data published in English between 1980 and 2002. Results: Despite successful surgery, Barrett's esophagus developed in 5.8-18.9% of patients with gastroesophageal reflux disease. The rate was higher in patients receiving medical therapy (11.1-33.8%). In long-term follow-up studies the mucosal changes (length of Barrett's mucosa, histological malformations) were reported to progress in 13.8-40.7% of patients after medical therapy and in 3.4-15.3% after surgical intervention. The risk of developing esophageal carcinoma on grounds of Barrett's esophagus was 1.3-4.6 and 0-8.1% in patients receiving medical and surgical treatment, respectively. In the published studies, the rate of complete regression of Barrett's esophagus following surgery varied between 0 and 26.4%. Discussion: Long-term follow-up studies confirm the histological progression in Barrett's esophagus. Therefore, the current medical or surgical therapies do not prevent malignant transformation of the columnar epithelial lining of the esophagus. However, their combination may delay progression and cancer formation.