Dr. Lai points out that the broader definition of Barrett esophagus can include the presence of metaplastic columnar epithelium that replaces the normal stratified squamous epithelium in the distal esophagus. Guidelines of both the American College of Gastroenterology1 and the American Gastroenterological Association2 require the presence of intestinal mucosa for the diagnosis of Barrett esophagus, as only intestinal metaplasia is associated with the risk of malignant transformation. Therefore, we recommend using the same standard definition.
The second point concerns the duration of therapy in Barrett esophagus. We recommend therapy with proton pump inhibitors indefinitely.
Lastly, we agree that use of statins has shown improved outcomes in patients with esophageal cancer,3 but the existing data on this topic are limited, and a specific recommendation regarding use of statins for this indication cannot be made with the available data. Randomized controlled trials are certainly needed to determine the association between statins and decreased mortality risk from esophageal cancer.
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