Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. May 6, 2016; 7(2): 190-206
Published online May 6, 2016. doi: 10.4292/wjgpt.v7.i2.190
Barrett’s esophagus in 2016: From pathophysiology to treatment
Irene Martinucci, Nicola de Bortoli, Salvatore Russo, Lorenzo Bertani, Manuele Furnari, Anna Mokrowiecka, Ewa Malecka-Panas, Vincenzo Savarino, Edoardo Savarino, Santino Marchi
Irene Martinucci, Nicola de Bortoli, Salvatore Russo, Lorenzo Bertani, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy
Manuele Furnari, Vincenzo Savarino, Division of Gastroenterology, University of Genoa, 16100 Genoa, Italy
Anna Mokrowiecka, Ewa Malecka-Panas, Department of Digestive Tract Diseases, Medical University of Lodz, 90-127 Lodz, Poland
Edoardo Savarino, Division of Gastroenterology, University of Padua, 35100 Padua, Italy
Author contributions: Martinucci I and de Bortoli N contributed to this paper by conceiving of and designing the study; Martinucci I, de Bortoli N and Savarino E reviewed and analyzed the literature; Martinucci I, de Bortoli N, Russo S, Bertani L, Furnari M, Mokrowiecka A and Malecka-Panas E drafted the paper; Savarino E, Savarino V and Marchi S performed the critical revision and editing of the manuscript; all authors approved the final version of the study.
Conflict-of-interest statement: The authors declare no potential conflicts of interest and no financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Irene Martinucci, MD, Division of Gastroenterology, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy. martinucci.irene@gmail.com
Telephone: +39-050-997395 Fax: +39-050-997436
Received: July 30, 2015
Peer-review started: July 31, 2015
First decision: September 16, 2015
Revised: January 20, 2016
Accepted: March 17, 2016
Article in press: March 18, 2016
Published online: May 6, 2016
Processing time: 265 Days and 19.4 Hours
Abstract

Esophageal complications caused by gastroesophageal reflux disease (GERD) include reflux esophagitis and Barrett’s esophagus (BE). BE is a premalignant condition with an increased risk of developing esophageal adenocarcinoma (EAC). The carcinogenic sequence may progress through several steps, from normal esophageal mucosa through BE to EAC. A recent advent of functional esophageal testing (particularly multichannel intraluminal impedance and pH monitoring) has helped to improve our knowledge about GERD pathophysiology, including its complications. Those findings (when properly confirmed) might help to predict BE neoplastic progression. Over the last few decades, the incidence of EAC has continued to rise in Western populations. However, only a minority of BE patients develop EAC, opening the debate regarding the cost-effectiveness of current screening/surveillance strategies. Thus, major efforts in clinical and research practice are focused on new methods for optimal risk assessment that can stratify BE patients at low or high risk of developing EAC, which should improve the cost effectiveness of screening/surveillance programs and consequently significantly affect health-care costs. Furthermore, the area of BE therapeutic management is rapidly evolving. Endoscopic eradication therapies have been shown to be effective, and new therapeutic options for BE and EAC have emerged. The aim of the present review article is to highlight the status of screening/surveillance programs and the current progress of BE therapy. Moreover, we discuss the recent introduction of novel esophageal pathophysiological exams that have improved the knowledge of the mechanisms linking GERD to BE.

Keywords: Gastroesophageal reflux disease; Barrett’s esophagus; Esophageal adenocarcinoma; Impedance and pH monitoring; Endoscopy

Core tip: The review highlights the significant progress in the diagnostic and therapeutic management of Barrett’s esophagus (BE) thanks to the development of up-and-coming endoscopic technologies. Moreover, we discuss the recent introduction of novel esophageal pathophysiological exams that have improved the knowledge of the mechanisms implicated in the genesis of esophageal mucosal damage, paving the way to the future possibility of predicting BE neoplastic progression. The comparison of endoscopic surveillance and eradication therapy recommendations for BE in currently available guidelines are provided.