Esofago De Barret

The

n e w e ng l a n d j o u r na l

of

m e dic i n e

clinical practice

Barrett’s Esophagus
Prateek Sharma, M.D.
This Journal feature begins with a case vignette highlighting a commonclinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations.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 of20 mg twice daily and currently has no symptoms of reflux. He has no dysphagia or weight loss. Endoscopic and histopathological examinations show a 4-cm segment of Barrett’s esophagus withoutdysplasia. How should Barrett’s esophagus be managed?

The Cl inic a l Probl em
Barrett’s esophagus is a premalignant lesion detected in the majority of patients with esophageal and gastroesophagealadenocarcinoma — cancers that are associated with a low rate of survival (5-year survival rate, 15 to 20%).1 The incidence of esophageal adenocarcinoma has been increasing in the United States.2 In 2009, itis 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 of esophageal adenocarcinoma is 30 to 40times as high among patients with Barrett’s This article (10.1056/NEJMcp0902173) was esophagus as among patients without this condition. The progression of Barrett’s updated on April 14, 2010, atNEJM.org. esophagus may involve the development of low-grade dysplasia and high-grade dysplasia before the eventual development of cancer. N Engl J Med 2009;361:2548-56. Copyright © 2009 MassachusettsMedical Society. Barrett’s esophagus is diagnosed in approximately 10 to 15% of patients with reflux who are undergoing endoscopy; it has also been reported in patients without chronic reflux symptoms,...