Medical Therapy versus Antireflux Surgery in Barrett’s Esophagus: What Is the Best Therapeutic Approach?

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Abstract
We conducted a review of the literature comparing medical treatment with antireflux surgery in patients with Barrett’s esophagus (BE). In particular, we wanted to assess the efficacy of medical and surgical therapies in preventing the progression of Barrett’s epithelium to dysplasia or adenocarcinoma of the esophagus. In general, few BE patients show complete regression of BE epithelium following medical or surgical therapy. The incidence of developing dysplasia or cancer following surgical therapy appears to be less than with medical therapy; however, there is an insufficient number of current, randomized controlled studies to confirm this. Surveillance of BE is required regardless of treatment. This review suggests that there may be a trend in support of surgery being somewhat better than medical therapy in the prevention of BE progression and adenocarcinoma. We suggest that patients with BE should be considered for antireflux surgery – in particular, certain subgroups of BE patients.