Barrett's esophagus: an old entity rediscovered

I have reviewed Barrett's esophagus in the light of recent advances. Barrett's esophagus is not as rare as general practitioners and gastroenterologists think. Present evidence suggests that the disorder is acquired as a complication of reflux esophagitis. The epithelium is prone to inflammation, ulceration, bleeding, stricture, and adenocarcinoma. The epithelium may contain chief and/or oxyntic cells; pepsinogens are demonstrable by agar gel electrophoresis in the mucosa and Barrett's epithelium secretes pepsin and acid, and also contains gastrin by radioimmunoassay. Pertechnetate scintigraphy in the screening of these patients may be helpful. In the treatment of these patients, anti-reflux operations stop the progressive ascent of the heterotopic epithelium, prevent inflammation, and stricture formation, and lead to healing of the mucosa. Cimetidine and bethanechol along with the conventional medical regimen for reflux esophagitis may also be helpful in healing the inflamed mucosa. Adenocarcinoma in Barrett's epithelium may have a better prognosis than gastric carcinoma which invade the esophagus or than esophageal carcinoma.