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      "@value" : "SUMMARY\nEsophageal adenocarcinoma presents a more rapidly rising\nincidence than all other cancers and arises in most patients\nfrom its premalignant precursor, Barrett’s esophagus.\nBarret’s esophagus is associated with chronic GERD and\nrepresents the severest form of this disease. PPIs can\nmarkedly decrease acid reflux, but only antireflux surgery\ncan successfully restore the function of the incompetent\nantireflux barrier. Antireflux surgery may be superior to\ncontrolling acid reflux alone, because it also eliminates the\npossible dangerous contributions of bile salts and\npancreatic enzymes. However, current data suggest that both\nmedical and surgical therapies are very effective in symptom\nrelief and healing of esophagitis over the long term, but\nneither treatment predictably causes Barrett’s metaplasia to\nregress, nor protects the patient from subsequently\ndeveloping adenocarcinoma of the esophagus. Even if\nantireflux surgery could prevent esophageal cancer, its use\nonly for this purpose could not be justified because the\nsurgical mortality rate, at least 0,2%, far exceeds the annual\nincidence of cancer, estimated at 0,07%. Therefore, it seems\nprudent for gastroenterologists and surgeons to be honest\nwith their patients about the outcomes of current\nestablished treatments of GERD. Given this information,\nand after a thoughtful discussion of both therapies, we\nbelieve patients can choose the regimen that best suits their\nindividual needs. Key words: GERD, Barrett’s esophagus, antireflux surgery,\nesophageal adenocarcinoma."
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