Purpose of review: Strides have been made in the past year to identify means of decreasing mortality from esophageal adenocarcinoma. This requires a thorough understanding of the risk factor for its development, Barrett esophagus. This article summarizes the most up-to-date and important advancements involving the epidemiology, screening, pathogenesis, surveillance, and treatment of Barrett esophagus over the past year.
Recent findings: Much of the literature over the past year involving Barrett esophagus centered on selecting subsets of patients who would benefit most from screening and surveillance protocols. Risk factors such as increasing age, heartburn symptoms, increasing length of Barrett's segment, and male sex are increasingly identified as increasing the risk for malignant esophageal transformation. New technologies, using smaller endoscopes, may allow more cost-effective screening in selected patient populations. Methylene blue continues to grow in acceptance for its utility in assisting identification of Barrett esophagus during endoscopy. Some concern has been raised recently about DNA damage secondary to the use of methylene blue, but the clinical significance of this is unknown. High-magnification endoscopy to identify certain mucosal patterns suggesting Barrett esophagus is also gaining acceptance, perhaps allowing more accurate surveillance in patients with this condition. Much controversy continues regarding the treatment of Barrett esophagus to prevent the development of esophageal adenocarcinoma. Data reports may show some advantage of surgical antireflux therapy in reducing the risk of adenocarcinoma, but a recent meta-analysis disputes this claim. Chromosomal abnormalities resulting in tumor suppressor dysfunction continue to be revealed.
Summary: The past year has brought many new advances involving the diagnosis, surveillance, and treatment of Barrett esophagus. It is important for physicians to be aware of these developments, to identify individuals in whom interventions may be undertaken to decrease the risk of the development of esophageal adenocarcinoma.