Barrett Esophagus: Rapid Evidence Review

Area of Science:

• Gastroenterology
• Oncology
• Preventive Medicine

Background:

• Barrett esophagus is a premalignant esophageal condition affecting up to 5.6% of the U.S. population.
• Risk factors include gastroesophageal reflux disease, obesity, age over 50, male sex, smoking, and family history.
• Malignant transformation to esophageal adenocarcinoma is rare without dysplasia.

Purpose of the Study:

• To outline the diagnosis, management, and surveillance of Barrett esophagus.
• To highlight risk factors and screening recommendations.
• To discuss the role of medications in managing Barrett esophagus and associated risks.

Main Methods:

• Diagnosis involves upper endoscopy with biopsies to identify mucosal changes and dysplasia.
• Management strategies depend on dysplasia severity, including endoscopic treatment.
• Surveillance aims to detect dysplasia and early-stage esophageal adenocarcinoma.

Main Results:

• Endoscopic treatment of dysplasia reduces malignant transformation risk.
• Proton pump inhibitors manage reflux and may lower adenocarcinoma risk.
• Statins, NSAIDs, and aspirin show potential risk reduction but lack definitive indications.

Conclusions:

• Barrett esophagus requires vigilant management, tailored to dysplasia presence and severity.
• Screening is recommended for individuals with chronic reflux and additional risk factors.
• While certain medications show promise, their use should be based on established indications; mortality benefits of screening and surveillance remain uncertain.