Barrett's esophagus as a premalignant condition; medical and surgical therapeutic management

Abstract

Barrett's esophagus (BE) represents a special clinical entity, which may have reduced symptoms, but an increased potential for malignant degeneration. The factors that lead to the appearance of Barrett's esophagus are multiple, the most important being gastro-esophageal reflux, as well as smoking and obesity. BE occurs as a result of damage of the esophageal mucosa, caused by acid/basic gastroesophageal reflux and resulting in the transformation of the epithelium from squamous to intestinal type. The diagnosis of BE is primarily based on endoscopic examination. This method has not only a diagnostic role, but also a therapeutic one through the minimally invasive resection of the mucosa with suspicious dysplastic lesions, thus reducing the risk of esophageal adenocarcinoma. Conservative therapeutic methods by administering chemoprotective agents (proton pump inhibitors, statins, etc.) are also useful. Surgical treatment of Barrett's esophagus aims to both resect areas of high-grade esophageal dysplasia/adenocarcinoma and reduce the degree of gastroesophageal reflux through various surgical procedures. As a conclusion, the potential for malignant degeneration of BE should not be neglected, the form of treatment largely depending on the patient's age and comorbidities.