Barrett's metaplasia: clinical implications

The incidence of Barrett's metaplasia (BM) as well as Barrett's adenocarcinoma (BA) has been increasing in western populations. The prognosis of BA is worse because individuals present at a late stage. Attempts have been made to intervene at early stage using surveillance programmes, although proof of efficacy of endoscopic surveillance is lacking, particularly outside the specialist centres. The management of BM needs to be evidence-based as there is a lack clarity about how best to treat this condition. The role of proton pump inhibitors and antireflux surgery to control reflux symptoms is justified. Whether adequate control of gastroesophageal reflux early in the disease alters the natural history of Barrett's change once it has developed, and/or prevents it in patients with gastroesophageal reflux disease but with no Barrett's change, remains unanswered. There is much to be learned about BM. Thus there is great need for carefully designed large randomised controlled trials to address these issues in order to determine how best to manage patients with BM.