Management of the patient with Barrett's esophagus: a continuing dilemma for the clinician.

Overview

The primary controversy regarding Barrett's esophagus (BE) relates to what form of therapy is "best" and, more importantly, whether any therapy results in the regression of abnormal epithelium or reduces the rate of progression to dysplasia and/or adenocarcinoma. The current standard of practice suggests that patients with BE should be treated in a similar fashion as patients with typical gastroesophageal reflux disease, that is, with antisecretory agents as needed to provide complete symptom relief. The most recent guidelines from the American College of Gastroenterology point out that there are no prospective studies that support any alternative approach to treatment (ie, neither high-dose acid suppression nor antireflux surgery has demonstrated reduced risk of dysplasia or esophageal adenocarcinoma). However, accumulating evidence suggests that simply controlling symptoms is inadequate.