This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Anatomy
What is TRUE regarding Barrett&;s esophagus - 
Select and explain. 
A. Seen in females, B. Responds to conservative management, C. Premalignant condition, D. Squamous metaplasia is seen
C: Premalignant condition
Answer: C: Premalignant condition 
Explanation: Barrett&;s esophagus is more common in men than in women (3 : 1 ratio) Barrett&;s esophagus can be reversed but only with antireflux surgery (response to medications is not good). A fundoplication may promote regression of the columnar epithelium. Many studies have shown that regression occurs in 15-50% of patients when the length of the Barrett segment is less than 3 cm." The common belief that Barrett&;s epithelium cannot be reversed is likely false. DeMeester and associates repoed that, after antireflux surgery, loss of IM (intestinal metaplasia) in patients with visible BE was rare, but occurred in73% of patients with inapparent IM of the cardia. This suggests that the metaplastic process may indeed be reversible if reflux is eliminated early in its process, that cardiac mucosa is dynamic, and that, as opposed to IM extending several centimeters into the esophagus, IM of the cardia is more likely to regress following antireflux surgery. More about the tit of Barret&;s oesophagus First, the natural course of Barrett&;s oesophagus. - Barrett&;s esophagus develops during healing of erosive esophagitis with continued acid reflux and the Barrett&;s esophagus progresses through a dysplastic stage before developing into adenocarcinoma. The stages are - Erosive esophagitis - Metaplasia (Barrett&;s esophagus) - Low grade dysplasia - high grade dysplaisa - Adenocarcinoma Treatment of Barrett&;s esophagus is same as for reflux esophagitis - Conservative (antacids, H2 blocking agents, elevation of the head of bed, and avoidance of smoking and alcohol etc.) and Anti-reflux surgery (Nissen&;s fundoplication is anti-reflux procedure of choice) As there is substantial increased risk of cancer with Barrett&;s esophagus, a regular follow-up with endoscopy and biopsy is done. This allows detection of cancer at an early stage with improved long-term survival after resection In the absence of dysplasia - Surveillance endoscopy every 12-24 months. In the presence of low-grade dysplasia - Patients with low grade dysplasia should be treated for 12 weeks with high-dose acid suppression therapy and then biopsy repeated. (the rationale for this approach is to decrease the mucosal inflammation by blocking acid secretion, allowing the pathologist a more accurate reading),If the repeated biopsy show metaplasia or high-grade dysplasia, the patient should be managed accordingly. If repeated low-grade dysplasia is seen- surveillance endoscopy is done every 6-12 months. If high grade dysplasia is detected (the diagnosis must be confirmed by two experienced pathologist) - esophagectomy with removal of all columnar lined epithelium or if resection is not done, then the patient should be strictly followed at 3 monthly interval. If cancer is detected resection is done. Rationale for esophagectomy in high grade dysplasia is based on the following considerations- (a) cancer is already present in about 30 to 50% of patients operated for high grade dysplasia. (b) cancer develops in about 50% fo patients during follow up.) Ref : CSDT 13/e p438 ; Schwaz 9/e p841