Barrett's esophagus: Management and surveillance. Article seven in the series

Over the past 5 years, the treatment and evaluation of Barrett's metaplasia has gone from a simple proposal of treating reflux and screening all patients equally to a complex algorithm of disease-specific treatment options and various screening protocols depending on the type of Barrett's epithelium and level of dysplasia. The essentials of today's treatments are to achieve complete elimination of gastroesophageal reflux as measured by ambulatory pH monitoring through either proton pump inhibitors or fundoplication, with an eye toward the future on techniques to ablate completely the metaplastic epithelium. The need for screening is now determined by the histologic type of Barrett's mucosa that is present, and methods of screening involve aggressive biopsy sampling of the entire length of the metaplastic epithelium, a review of dysplastic mucosa by an expert in the field, and developing new screening techniques to improve accuracy of detection and prediction of which patients may go on the develop dysplasia and carcinoma.