This Journal feature begins with a case vignette highlightinga common clinical problem. Evidence supporting various strategiesis then presented, followed by a review of formal guidelines,when they exist. The article ends with the author's clinicalrecommendations.
A 55-year-old obese white man has had frequent heartburn formore than 10 years. He has treated himself with a histamineH2-receptor antagonist, which provides only partial relief.He decided to consult a physician after reading a magazine articlewarning that heartburn causes cancer of the esophagus. The patienthas no other medical problems, dysphagia, or recent, unexplainedweight loss, and . . . [Full Text of this Article]
The Clinical Problem
Strategies and Evidence
Screening and Surveillance for Barrett's Esophagus
Treatment of Gastroesophageal Reflux Disease in Barrett's Esophagus
Dysplasia in Barrett's Esophagus
Natural History of High-Grade Dysplasia
Helicobacter pylori and Barrett's Esophagus
Areas of Uncertainty
Guidelines
Conclusions
Source Information
From the Dallas Department of Veterans Affairs Medical Center and the University of Texas Southwestern Medical Center at Dallas, Dallas.
Address reprint requests to Dr. Spechler at the Division of Gastroenterology (111B1), Dallas VA Medical Center, 4500 S. Lancaster Rd., Dallas, TX 75216.
References
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[Abstract]
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[Abstract][Full Text]
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[Abstract][Full Text]
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[Full Text]
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[Abstract][Full Text]
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[Abstract]
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[Full Text]
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Wang, T. D., Triadafilopoulos, G., Crawford, J. M., Dixon, L. R., Bhandari, T., Sahbaie, P., Friedland, S., Soetikno, R., Contag, C. H.
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[Abstract][Full Text]
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[Abstract][Full Text]
Keswani, R. N., Noffsinger, A., Waxman, I., Bissonnette, M.
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Nishioka, N. S., Lauwers, G. Y.
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(2006). Genetic Mechanisms of TP53 Loss of Heterozygosity in Barrett's Esophagus: Implications for Biomarker Validation.. Cancer Epidemiol. Biomarkers Prev.
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[Abstract][Full Text]
Schottenfeld, D., Beebe-Dimmer, J.
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56: 69-83
[Abstract][Full Text]
Brundler, M-A, Harrison, J A, de Saussure, B, de Perrot, M, Pepper, M S
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[Abstract][Full Text]
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[Abstract][Full Text]
von Rahden, B. H.A., Stein, H. J., Puhringer, F., Koch, I., Langer, R., Piontek, G., Siewert, J. R., Hofler, H., Sarbia, M.
(2005). Coexpression of Cyclooxygenases (COX-1, COX-2) and Vascular Endothelial Growth Factors (VEGF-A, VEGF-C) in Esophageal Adenocarcinoma. Cancer Res.
65: 5038-5044
[Abstract][Full Text]
Deviere, J
(2005). Barrett's oesophagus: the new endoscopic modalities have a future. Gut
54: i33-i37
[Abstract][Full Text]
Bergman, J J G H M, Tytgat, G N J
(2005). New developments in the endoscopic surveillance of Barrett's oesophagus. Gut
54: i38-i42
[Abstract][Full Text]
Hage, M, Siersema, P D, van Dekken, H, Steyerberg, E W, Haringsma, J, van de Vrie, W, Grool, T E, van Veen, R L P, Sterenborg, H J C M, Kuipers, E J
(2004). 5-Aminolevulinic acid photodynamic therapy versus argon plasma coagulation for ablation of Barrett's oesophagus: a randomised trial. Gut
53: 785-790
[Abstract][Full Text]
Koshy, M., Esiashvilli, N., Landry, J. C., Thomas, C. R. Jr., Matthews, R. H.
(2004). Multiple Management Modalities in Esophageal Cancer: Epidemiology, Presentation and Progression, Work-up, and Surgical Approaches. The Oncologist
9: 137-146
[Abstract][Full Text]
Abbas, A. E., Deschamps, C., Cassivi, S. D., Allen, M. S., Nichols, F. C. III, Miller, D. L., Pairolero, P. C.
(2004). Barrett's esophagus: the role of laparoscopic fundoplication. Ann. Thorac. Surg.
77: 393-396
[Abstract][Full Text]
Enzinger, P. C., Mayer, R. J.
(2003). Esophageal Cancer. NEJM
349: 2241-2252
[Full Text]
Luedtke, P., Levine, M. S., Rubesin, S. E., Weinstein, D. S., Laufer, I.
(2003). Radiologic Diagnosis of Benign Esophageal Strictures: A Pattern Approach. RadioGraphics
23: 897-909
[Abstract][Full Text]
Spechler, S. J.
(2003). Managing Barrett's oesophagus. BMJ
326: 892-894
[Full Text]
Metz, D. C., Alberts, D. S.
(2003). Gastrointestinal Cancer Prevention in the United States: The Road Ahead. Cancer Epidemiol. Biomarkers Prev.
12: 81-83
[Full Text]
Spechler, S. J.
(2003). A 59-Year-Old Woman With Gastroesophageal Reflux Disease and Barrett Esophagus. JAMA
289: 466-475
[Full Text]