Barrett's Esophagus Without Dysplasia

Definition and Pathophysiology

Barrett's esophagus is defined as the presence of intestinal metaplasia in any length of the tubular esophagus, representing a change from the normal squamous epithelium to columnar epithelium as a result of chronic gastroesophageal reflux disease, according to the American Gastroenterological Association 1, 2, 3, 4
The current accepted definition requires the presence of intestinal metaplasia for diagnosis, regardless of segment length, as stated by the American College of Gastroenterology 1
Evidence shows that intestinal metaplasia carries a higher cancer risk, as reported by the British Society of Gastroenterology 5

Barrett's esophagus is present in approximately 5-15% of patients with long-term reflux symptoms, according to the American College of Gastroenterology 1, 2
Less than 1% of the general population has Barrett's esophagus, as reported by the American Gastroenterological Association 1
Risk factors include history of gastroesophageal reflux disease, as stated by the European Society of Gastrointestinal Endoscopy 4
Tobacco use is also a risk factor, as reported by the American College of Gastroenterology 4
Family history is a risk factor, according to the British Society of Gastroenterology 4

Barrett's esophagus is the only known precursor to esophageal adenocarcinoma, as stated by the American Cancer Society 4
The relative risk of developing cancer is 40-125 times higher than the general population, according to the National Comprehensive Cancer Network 2, 6
The absolute risk of progression to adenocarcinoma is approximately 0.5% per patient-year, as reported by the American College of Gastroenterology 2, 6
Progression to cancer occurs through an intermediate stage of dysplasia, according to the European Society of Gastrointestinal Endoscopy 4

Pharmacologic treatment with proton pump inhibitors is recommended for symptom control but not specifically for cancer prevention, as stated by the American Gastroenterological Association 8, 9
High-dose acid suppression alone does not cause substantial regression of Barrett's esophagus, according to the American College of Gastroenterology 7
Endoscopic eradication therapy is not recommended for patients with non-dysplastic Barrett's esophagus except in select high-risk individuals, as reported by the British Society of Gastroenterology 8, 9

Autopsy studies suggest that the majority of Barrett's esophagus cases are never diagnosed during life, according to the American College of Gastroenterology 1
Most patients who develop cancer in the setting of Barrett's esophagus were unaware of having the condition before their cancer diagnosis, as reported by the National Comprehensive Cancer Network 1
Dysplasia and early cancer often develop without clinical signs, even in patients whose symptoms are well-controlled on acid suppressant medications, according to the European Society of Gastrointestinal Endoscopy 4
Patients should be fully informed about the implications of this diagnosis and the benefits and risks of monitoring strategies, as stated by the British Society of Gastroenterology 4

If dysplasia develops, management changes significantly with more frequent surveillance or endoscopic eradication therapy, according to the American Gastroenterological Association 9
The diagnosis of dysplasia should be confirmed by at least two pathologists, preferably with one being an expert in esophageal histopathology, before initiating endoscopic eradication therapy, as reported by the American College of Gastroenterology 9