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  • Review Article
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Barrett esophagus: an update

Nature Reviews Gastroenterology & Hepatology volume 7, pages 369–378 (2010)Cite this article

Subjects

Abstract

Many developments have been made in the field of Barrett esophagus that have tremendous clinical implications. There are new definitions of Barrett esophagus that have had an immediate clinical impact on cancer risk and screening. Of interest is the definition by the British Society of Gastroenterology, which does not require the presence of intestinal metaplasia for a diagnosis of Barrett esophagus. Imaging techniques that allow improved visualization of intestinal metaplasia at the cellular level are now being used in clinical practice. New hypotheses elucidating the progression from squamous epithelium to intestinal metaplasia have been proposed. Indeed, the crucial role that transcription factors have in the pathogenesis of Barrett esophagus has been clarified. Improved characterization of the molecular mechanisms underlying Barrett esophagus is an incentive to undertake more basic science research in this field. Such research could also help with the development of chemoprevention strategies for this precancerous condition. This Review discusses the advances in understanding of the pathogenesis, diagnosis and treatment of Barrett esophagus.

Key Points

  • The field of Barrett esophagus is evolving, with advances in understanding of the pathogenesis, diagnosis and treatment of this premalignant condition

  • In the USA, the presence of both salmon-colored mucosa on upper endoscopy and specialized intestinal metaplasia in biopsy specimens is required to diagnose Barrett esophagus

  • New concepts regarding the pathogenesis of Barrett esophagus have been elucidated; CDX2 and BMP4 are thought to have a key role in the pathogenesis of this condition

  • New imaging techniques, such as narrow band imaging and confocal laser microscopy, are helping in the diagnosis of Barrett esophagus

  • Ablative techniques, including radiofrequency ablation, are becoming increasingly accepted treatments for Barrett esophagus given their low complication rate and high eradication rate

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Figure 1: The Prague classification of Barrett esophagus.
Figure 2: Molecular pathways involved in the development of Barrett esophagus.
Figure 3
Figure 4
Figure 5: Algorithm for the management of patients with Barrett esophagus.

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Acknowledgements

Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Salem Gastroenterology Associates, 1830 S. Hawthorne Road, Winston-Salem, 27103, NC, USA

    Rami J. Badreddine

  2. Division of Gastroenterology and Hepatology, Barrett's Esophagus Unit, Mayo Clinic, 200 First Street SW, Rochester, 55905, MN, USA

    Kenneth K. Wang

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  1. Rami J. Badreddine
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Correspondence to Rami J. Badreddine.

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Badreddine, R., Wang, K. Barrett esophagus: an update. Nat Rev Gastroenterol Hepatol 7, 369–378 (2010). https://doi.org/10.1038/nrgastro.2010.78

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