Barrett’s esophagus


Summary 1) Wikipedia

Barrett’s esophagus (British English: Barrett’s oesophagus), sometimes called Barrett syndrome, Barrett esophagus, or columnar epithelium lined lower oesophagus (CELLO), refers to an abnormal change (metaplasia) in the cells of the lower portion of the esophagus. It is characterized by the replacement of the normal stratified squamous epithelium lining of the esophagus by simple columnar epithelium with goblet cells (which are usually found lower in the gastrointestinal tract).

Pathophysiology 2)

Barrett’s esophagus

The development of Barrett’s esophagus is likely a two step process. The first step involves the transformation of normal esophageal squamous mucosa to a simple columnar epithelium called cardiac mucosa. This occurs in response to chronic injury produced by repetitive episodes of gastric juice refluxing onto the squamous mucosa. The change from squamous to cardiac mucosa likely occurs relatively quickly, within a few years, while the second step, the development of goblet cells indicative of intestinal metaplasia, proceeds slowly, probably over 5-10 years. Once present, Barrett’s esophagus can progress to low and high-grade dysplasia, and ultimately to adenocarcinoma. This entire process is commonly described as the Barrett’s metaplasiadysplasia-carcinoma sequence.

Causes 3) Robbins Basic Pathology by Vinay Kumar

  • Long-standing GERD

Symptoms 4) Wikipedia

  • Frequent and longstanding heartburn 
  • Pain under the sternum where the esophagus meets the stomach 
  • Trouble swallowing (dysphagia) 
  • Unintentional weight loss because eating is painful 
  • Vomiting blood (hematemesis)

Barrett’s esophagus with reticular mucosa and web-like (arrow) stricture

Diagnosis 5)Wikipedia6)

  • Endoscopy – marked by the presence of columnar epithelia in the lower esophagus, replacing the normal squamous cell epitheliuman example of metaplasia
  • Barium swallow – mid or high esophageal ulcer, mid or high esophageal web-like stricture and reticular mucosal pattern

Treatment 7) Wikipedia

  • Proton pump inhibitor drugs  reduces gastric secretion
  • Photodynamic therapy using photofrin  eliminates dysplastic growth areas
  • Nissen fundoplication – reduce the reflux of acid from the stomach into the esophagus

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