title: A critical review of the diagnosis and management of Barrett's esophagus: the AGA Chicago Workshop.
abstract: OBJECTIVE
  The diagnosis and management of Barrett's esophagus (BE) are controversial. We conducted a critical review of the literature in BE to provide guidance on clinically relevant issues.
  
  
  METHODS
  A multidisciplinary group of 18 participants evaluated the strength and the grade of evidence for 42 statements pertaining to the diagnosis, screening, surveillance, and treatment of BE. Each member anonymously voted to accept or reject statements based on the strength of evidence and his own expert opinion.
  
  
  RESULTS
  There was strong consensus on most statements for acceptance or rejection. Members rejected statements that screening for BE has been shown to improve mortality from adenocarcinoma or to be cost-effective. Contrary to published clinical guidelines, they did not feel that screening should be recommended for adults over age 50, regardless of age or duration of heartburn. Members were divided on whether surveillance prolongs survival, although the majority agreed that it detects curable neoplasia and can be cost-effective in selected patients. The majority did not feel that acid-reduction therapy reduces the risk of esophageal adenocarcinoma but did agree that nonsteroidal antiinflammatory drugs are associated with a cancer risk reduction and are of promising (but unproven) value. Participants rejected the notion that mucosal ablation with acid suppression prevents adenocarcinoma in BE but agreed that this may be an appropriate strategy in a subgroup of patients with high-grade dysplasia.
  
  
  CONCLUSIONS
  Based on this review of BE, the opinions of workshop members on issues pertaining to screening and surveillance are at variance with published clinical guidelines.
authors.affiliation: University of Kansas School of Medicine and VA Medical Center, Kansas City, Missouri 64128-2295, USA. psharma@kumc.edu
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.forename: Kenneth
authors.initials: K
authors.lastname: McQuaid
authors.forename: John
authors.initials: J
authors.lastname: Dent
authors.forename: M Brian
authors.initials: MB
authors.lastname: Fennerty
authors.forename: Richard
authors.initials: R
authors.lastname: Sampliner
authors.forename: Stuart
authors.initials: S
authors.lastname: Spechler
authors.forename: Alan
authors.initials: A
authors.lastname: Cameron
authors.forename: Douglas
authors.initials: D
authors.lastname: Corley
authors.forename: Gary
authors.initials: G
authors.lastname: Falk
authors.forename: John
authors.initials: J
authors.lastname: Goldblum
authors.forename: John
authors.initials: J
authors.lastname: Hunter
authors.forename: Janusz
authors.initials: J
authors.lastname: Jankowski
authors.forename: Lars
authors.initials: L
authors.lastname: Lundell
authors.forename: Brian
authors.initials: B
authors.lastname: Reid
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
authors.forename: Amnon
authors.initials: A
authors.lastname: Sonnenberg
authors.forename: Kenneth
authors.initials: K
authors.lastname: Wang
authors.forename: Wilfred
authors.initials: W
authors.lastname: Weinstein
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis* / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000473:pathology*; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011230:Precancerous Conditions / Q000473:pathology* / Q000628:therapy