Questions Regarding Surgery to Correct Short-Segment BE:  Comment on “Late Results of the Surgical Treatment of 125 Patients With Short-Segment Barrett Esophagus”

Barrett esophagus develops as a consequence of long-standing reflux of gastric juice into the esophagus, and it is likely that continued reflux drives the progression of BE to dysplasia and adenocarcinoma. Both acid and bile have been implicated in the development of BE, and increasingly there is evidence that the relative proportions of each and the resultant pH of the refluxed gastric juice may be important in this process. In many patients, BE, once it develops, never progresses. However, an important and unresolved issue is whether medical or surgical intervention can alter the natural history of BE such that progression does not occur in those in whom BE otherwise would have progressed. Regression or loss of intestinal metaplasia certainly suggests an alteration in the natural history, and Csendes and colleagues report in this issue of the Archives of Surgery that there was loss of intestinal metaplasia in approximately 60% of patients with short-segment BE after surgical correction of reflux. However, a number of important issues remain unanswered: