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