Predisposing Role of Immunologic determinants in the Etiology of Barrett’s Esophagus

Gastroesophageal reflux disease (GERD) is defined as the presence of symptoms or lesions\nthat can be attributed to reflux of gastric contents into the esophagus. In the Western\nworld, GERD represent one of the most common gastrointestinal problems [1,2]. Cardinal\nmanifestations of GERD are the presence of reflux symptoms such as heartburn, and the\npresence of gastroesophageal reflux. Heartburn is very common in Western populations\nwith over 40% of the general population having monthly symptoms, and approximately\n20% having symptoms on at least a weekly basis [1].\nGERD is a spectrum encompassing a broad range of conditions. Of all patients referred\nfor upper GI endoscopy for heartburn as their major symptom, 20-40 % have a reflux\nesophagitis, 6-12% have a Barrett’s esophagus (BE), and the remaining have endoscopynegative\nGERD [3-10]. The diagnosis of severe reflux esophagitis is important as treatment\ncan prevent the development of reflux related complications such as bleeding, stricture,\nand ulcers. Another important complication of chronic exposure to gastroesophageal reflux\nis the development of esophageal adenocarcinoma (EAC). Gastroesophageal reflux is\nconsidered to be the key element in the development of EAC since severe, longstanding,\nand frequent episodes of gastroesophageal reflux is associated with a seven- to eightfold\nincreased risk of EAC.