Barrett’s Esophagus, Fundoplication, and Cancer

Over recent decades, gastro-esophageal reflux and Barrett’s esophagus have become increasingly common in all Western countries, underpinning a 300–400% increase in the incidence of esophageal adenocarcinoma over the last 20 years. This rate of increase is faster than for any other human cancer, and it is likely that the incidence is still rising. Because of this, there has been a major shift in the dominant esophageal cancer subtype managed in Western countries, with 80–90% of esophagectomy operations now being performed for esophageal adenocarcinoma. Barrett’s esophagus is now clearly recognised to be the major risk factor for esophageal adenocarcinoma. Clinical and laboratory evidence suggest that reflux of both acid and bile, rather than acid alone, is required for the development of Barrett’s esophagus.1 Hence, it seems reasonable to assume that the adequacy of management of gastro-esophageal reflux in patients with Barrett’s esophagus will influence the risk of progression to cancer.