The normal esophagus is lined by cells that resemble skin called squamous epithelium. In some people, who have long standing Gastroesophgeal Reflux disease (GERD), chronic irritation caused by acid reflux causes squamous epithelium to change into a lining that resembles small intestinal mucosa. This change is called metaplasia. This change is generally seen at the lower end of the esophagus above the valve between the esophagus and stomach (Lower Esophageal Sphincter) and this metaplastic lining is known as Barrett’s Esophagus.

• Proton pump inhibitors (such as omeprazole, esomeprazole, pantoprazole, lansoprazole, and rabeprazole) are the most effective in reducing gastric acid secretion. These drugs stop acid secretion at the source of acid production, i.e. the proton pump.
• Gastric H2 receptor blockers (such as ranitidine, famotidine and cimetidine) can reduce gastric secretion of acid. These drugs are less potent than PPI but may be agent of choice in some patients.

GERD is a very common problem in the United States. It is estimated that 15% of the adult population suffer form GERD. The normal valve at the lower end of the esophagus (Lower esophageal Sphincter -LES) is tight and relaxes only with swallowing and thus prevents reflux of gastric acid into the esophagus. In patients with GERD there is inappropriate relaxation of LES causing acid reflux. In some patients the LES is very loose and these patients have severe GERD.