New treatments for Barrett's esophagus.

New treatments for Barrett's esophagus need to be looked at in the context of the goals of symptom relief, mucosal healing, and prevention of inflammatory and malignant complications. Pharmacological reduction of esophageal acid exposure is effective in controlling the symptoms of reflux and the healing of esophageal mucosa in the majority of patients. Antireflux surgery is similarly successful. Each of these therapeutic modalities rarely results in the reversal of Barrett's esophagus. Reducing the risk of the development of adenocarcinoma may require the elimination of all intestinal metaplasia in the esophagus. Experimentally, by endoscopic criteria this can be accomplished with combination therapy--esophagus acid control and endoscopic ablative techniques. Acid control can be achieved with high-dose proton pump inhibitor therapy or antireflux surgery. Elimination of intestinal metaplasia can be accomplished with laser, photodynamic and electrocoagulation therapy. A better definition of the subgroup of patients with Barrett's esophagus at a high risk of adenocarcinoma is necessary to identify appropriate candidates for combination therapy.