T h e n e

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T h e n e w e ngl a nd j o u r na l o f m e dic i n e Clinical Practice Barrett’s Esophagus Rebecca C. Fitzgerald, M.D.1 This Journal feature begins with a case vignette highlighting a common clinical 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. Summ a r y Barrett’s esophagus develops as a result of chronic acid and bile reflux and carries an increased risk of esophageal adenocarcinoma. Because it has no specific symp- toms, many patients do not receive a diagnosis or they present with symptoms of gastroesophageal reflux disease and other related risk factors or complications. Diagnosis relies on endoscopic and histopathological findings, including a visible columnar-cell–lined segment measuring at least 1 cm long that contains intestinal metaplasia with goblet cells. Ongoing surveillance focuses on early detection of malignant progression, particularly high-grade dysplasia and early-stage cancer, which allows curative endoscopic treatment and avoids the adverse effects associated with chemotherapy or esophagectomy. Participation in clinical...