The Reflux-to-Cancer Continuum: Current Strategies in Barrett's Esophagus Surveillance and Intervention

Abstract Background / Introduction The malignant transformation of esophageal squamous epithelium into columnar-lined metaplasia, known as Barrett's esophagus, serves as the primary precursor to esophageal adenocarcinoma. While historically a disease of Western populations, the rising prevalence of gastroesophageal reflux disease and central obesity has shifted the epidemiological landscape globally. Understanding the progression through the metaplasia-dysplasia-adenocarcinoma sequence is vital for effective clinical intervention. Objective This research report aims to synthesize current global strategies for the surveillance and intervention of Barrett’s esophagus, comparing clinical guidelines from the United States, United Kingdom, and India. It investigates the efficacy of advanced imaging, molecular biomarkers, and medical therapies, specifically potassium-competitive acid blockers, in reducing cancer progression. Methods A comprehensive review of clinical practice guidelines from the American College of Gastroenterology, American Gastroenterological Association, British Society of Gastroenterology, and Indian Society of Gastroenterology was conducted. Data were synthesized from population-based registries, systematic reviews, and meta-analyses published between 2014 and 2025, focusing on diagnostic criteria, surveillance intervals, and endoscopic eradication therapy outcomes. Results Diagnostic standards emphasize a minimum length of 1 cm for Barrett’s esophagus, with high-definition white light endoscopy and chromoendoscopy as the preferred surveillance modalities. The integration of molecular assays like TissueCypher and Esopredict has improved risk stratification. In South Asia, the prevalence of Barrett's remains relatively low despite high reflux rates, whereas Central Asia faces a rising burden of early-onset esophageal