Gastroesophageal Reflux Disease, Barrett Esophagus, and Esophageal Adenocarcinoma

T he incidence of esophageal adenocarcinoma has been rising rapidly over the past few decades. The major risk factors predisposing to the development of adenocarcinoma are long-standing gastroesophageal reflux disease and Barrett esophagus, but other factors may be involved as cancer can occur in their absence. In patients with Barrett esophagus, the extent and degree of dysplasia influence the risk of esophageal adenocarcinoma. As neither medical nor surgical therapies have been proven to prevent adenocarcinoma, endoscopic screening of patients with chronic reflux and endoscopic surveillance of patients diagnosed with Barrett esophagus are usually performed in an effort to detect adenocarcinomas at earlier stages. The evidence supporting strategies in the management of patients with gastroesophageal reflux and Barrett esophagus is presented. Arch Intern Med. 2004;164:1482-1488