title: Barrett's esophagus in 2016: From pathophysiology to treatment.
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.
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Salvatore Russo, Lorenzo Bertani, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Martinucci
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Salvatore Russo, Lorenzo Bertani, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: de Bortoli
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Salvatore Russo, Lorenzo Bertani, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Russo
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Salvatore Russo, Lorenzo Bertani, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bertani
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Salvatore Russo, Lorenzo Bertani, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Manuele
authors.initials: M
authors.lastname: Furnari
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Salvatore Russo, Lorenzo Bertani, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Mokrowiecka
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Salvatore Russo, Lorenzo Bertani, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Ewa
authors.initials: E
authors.lastname: Malecka-Panas
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Salvatore Russo, Lorenzo Bertani, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Savarino
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Salvatore Russo, Lorenzo Bertani, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Savarino
authors.affiliation: Irene Martinucci, Nicola de Bortoli, Salvatore Russo, Lorenzo Bertani, Santino Marchi, Division of Gastroenterology, University of Pisa, 56124 Pisa, Italy.
authors.forename: Santino
authors.initials: S
authors.lastname: Marchi
keywords: Barrett’s esophagus; Endoscopy; Esophageal adenocarcinoma; Gastroesophageal reflux disease; Impedance and pH monitoring