Debates

Barrett’s esophagus is a metaplastic change of the esophageal epithelium which increases the risk of esophageal adenocarcinoma by 10 to 30 fold. It is thought to progress via the development of dysplasia to esophageal adenocarcinoma (EAC). EAC is a lethal malignancy with poor outcomes when diagnosed after the onset of symptoms despite recommendations for screening […]

Debates

Aspirin is a commonly prescribed drug and its prevention of both cardiovascular and vascular events is well established. Recently, the benefits of aspirin from a chemoprevention standpoint, particularly in gastrointestinal tract cancers, have emerged. Prevention of esophageal adenocarcinomas is particularly relevant for Barrett’s esophagus patients, a premalignant condition affecting 2 percent of the adult population. […]

Quick Hits

Endoscopic eradication therapy (EET) with a combined approach of resection and ablation is safe and effective. The evolution of endoscopic mucosal resection (EMR) for visible lesions followed by radiofrequency ablation (RFA) has become the gold standard for Barrett’s associated neoplasia. Despite the effectiveness of EET, recurrence of intestinal metaplasia (IM) after achieving complete eradication (CE-IM) […]

Quick Hits

A meaningful discussion on the relevance of proton pump inhibitor–responsive esophageal eosinophilia (PPI-REE) in 2018 should first consider this question: How did we ever end up with this cumbersome term? Well, it arose as an artifact of early confusion regarding the need to distinguish eosinophilic esophagitis (EoE) from gastroesophageal reflux disease (GERD). This confusion led […]

Debates

Gastroesophageal reflux disease (GERD) testing has evolved ever since the initial introduction of the catheter-based pH test more than half a century ago. More accurate pH measurements and improved patient tolerability were achieved by reducing the catheter’s diameter and stiffness, and the catheter-based pH test has continued to improve over the years.1 Introduction of the […]

Debates

Prolonged pH or reflux monitoring is neither essential to the primary evaluation or treatment of patients with suspected gastroesophageal reflux disease (GERD) who respond to therapy nor needed for patients who have endoscopydocumented erosive esophagitis that responds to antisecretory therapy. The history, endoscopic findings and clinical response to therapy provide adequate support for the diagnosis of GERD in […]