Articulo barret

Barrett's Esophagus
Prateek Sharma, M.D.
A 56-year-old obese man with long-standing gastroesophageal reflux who recently received a diagnosis of Barrett's esophagus presents for a follow-up visit.He has been taking omeprazole at a dose of 20 mg twice daily and currently has no symptoms of reflux. He has no dysphagia or weight loss. Endoscopic and histopathological examinations show a 4-cmsegment of Barrett's esophagus without dysplasia. How should Barrett's esophagus be managed?
The Clinical Problem
Barrett's esophagus is a premalignant lesion detected in the majority of patients withesophageal and gastroesophageal adenocarcinoma — cancers that are associated with a low rate of survival (5-year survival rate, 15 to 20%).1 The incidence of esophageal adenocarcinoma has beenincreasing in the United States.2 In 2009, it is estimated that 16,400 new cases of esophageal cancer will be diagnosed in the United States, of which approximately 60% will be adenocarcinomas.3 The risk ofesophageal adenocarcinoma is 30 to 40 times as high among patients with Barrett's esophagus as among patients without this condition. The progression of Barrett's esophagus may involve the developmentof low-grade dysplasia and high-grade dysplasia before the eventual development of cancer.
Barrett's esophagus is diagnosed in approximately 10 to 15% of patients with reflux who are undergoingendoscopy; it has also been reported in patients without chronic reflux symptoms, with a prevalence of 5.6% in one report of endoscopic screening. The prevalence of Barrett's esophagus in the general U.S.population is not known. In a population-based study conducted in Sweden, Barrett's esophagus was diagnosed in 1.6% of 3000 study participants. If these numbers are applied to the U.S. population,1.5 to 2.0 million adults may have this premalignant lesion. Risk factors for Barrett's esophagus include advanced age, male sex, white race, symptoms of reflux, and obesity. Studies have reported...