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The prevention and treatment of dysplasia in gastroesophageal reflux disease: The results and the challenges ahead

The objectives for prevention and treatment are to eliminate the progression to cancer. Eliminating cancer risk removes lifelong worry for patients and eliminates the costs and potential morbidity associated with perpetual endoscopic biopsy surveillance. The overall magnitude of the cancer risk in Barrett’s esophagus is lower than formerly thought, with a current best guess being in the range of one cancer per 200–400 patient years of follow-up. The presence and histological grade of dysplasia remains the most widely available, validated, and accurate predictor of malignant risk. If we had data for risk, stratified according to baseline dysplasia status as we do for ulcerative colitis then it is a virtual certainty that the risk in patients who are negative for dysplasia over a 2-year period would be much lower than current estimates. Interventions might be difficult to justify in this low-risk group, but would be easier to justify in the group with dysplasia.