Barrett's oesophagus and carcinoma. Recent insights into its development and possible prevention.

Barrett's oesophagus or columnar epithelium-lined oesophagus is a condition due to chronic gastro-oesophageal reflux. In addition to acid-peptic reflux, reflux of duodenal contents may have a role in its aetiology. The clinical importance of Barrett's oesophagus is the increased risk for development of oesophageal adenocarcinoma. Measures to prevent cancer development have so far been limited to regular screening and early oesophagectomy in the case of severe dysplasia or early cancer. Other modes of intervention, directed toward prevention of dysplasia and possibly regression of Barrett's epithelium, should be sought. Early markers of development toward dysplasia and cancer are necessary if we are to be able to evaluate such measures. Determination of epithelial cell proliferative activity has the potential to be such a marker. A study is now being performed to evaluate the effect of elimination of acid reflux on proliferative activity of Barrett's epithelium in conjunction with the effects of inflammation and development of dysplasia.