Barrett's esophagus

From Wikipedia, the free encyclopedia

**Barrett's esophagus**
*Classification & external resources*
ICD-10	K 22.7
ICD-9	530.85
OMIM	109350
DiseasesDB	1246
MedlinePlus	001143
eMedicine	radio/73

Endoscopic image of Barrett's esophagus, which is the area of red mucosa projecting like a tongue. Biopsies showed intestinal metaplasia

Barrett's esophagus (sometimes called Barrett's syndrome, CELLO, columnar epithelium lined lower (o)esophagus or colloquially as Barrett's) refers to an abnormal change (metaplasia) in the cells of the lower end of the esophagus thought to be caused by damage from chronic acid exposure, or reflux esophagitis.^[1] Barrett's esophagus is found in about 10% of patients who seek medical care for heartburn (gastroesophageal reflux). It is considered to be a premalignant condition and is associated with an increased risk of esophageal cancer.^[2]

The condition is named after Dr. Norman Barrett (1903–1979), Australian-born British surgeon at St Thomas' Hospital, who described the condition in 1957.^[3]

1 Pathology
2 Treatment
3 References
4 External links

[edit] Pathology

Barrett's esophagus is marked by the presence of columnar epithelia in the lower esophagus, replacing the normal squamous cell epithelium—an example of metaplasia. The columnar epithelium is better able to withstand the erosive action of the gastric secretions; however, this metaplasia confers an increased cancer risk of the adenocarcinoma type.^[4]

The metaplastic columnar cells may be of two types: gastric (similar to those in the stomach, which is NOT technically Barrett's esophagus) or colonic (similar to cells in the intestines). A biopsy of the affected area will often contain a mixture of the two. Colonic-type metaplasia confers a higher risk of malignancy.

The metaplasia of Barrett's esophagus is visible grossly through a gastroscope, but biopsy specimens must be examined under a microscope to determine whether cells are gastric or colonic in nature. Colonic metaplasia is usually identified by finding goblet cells in the epithelium and is necessary for the true diagnosis of Barrett's.

[edit] Treatment

Current recommendations include routine endoscopy and biopsy (looking for dysplastic changes) every 12 months or so while the underlying reflux is controlled with proton pump inhibitor drugs in combination with measures to prevent reflux. In severe dysplasia, laser treatment is being used, whereas overt malignancy may require surgery, radiation therapy, or systemic chemotherapy. There is presently no reliable way to determine which patients with Barrett's esophagus will go on to develop esophageal cancer. Endoscopic mucosal resection (EMR) has also been evaluated as a management technique.^[5]

Additionally an operation known as a Nissen fundoplication can reduce the reflux of acid from the stomach into the esophagus.^[6]

[edit] References

^ Stein H, Siewert J (1993). "Barrett's esophagus: pathogenesis, epidemiology, functional abnormalities, malignant degeneration, and surgical management". Dysphagia 8 (3): 276-88. PMID 8359051.
^ Koppert L, Wijnhoven B, van Dekken H, Tilanus H, Dinjens W (2005). "The molecular biology of esophageal adenocarcinoma". J Surg Oncol 92 (3): 169-90. PMID 16299787.
^ Barrett N (1957). "The lower esophagus lined by columnar epithelium". Surgery 41 (6): 881-94. PMID 13442856.
^ Fléjou J (2005). "Barrett's oesophagus: from metaplasia to dysplasia and cancer". Gut 54 Suppl 1: i6-12. PMID 15711008.
^ Reshamwala P, Darwin P (2006). "Endoscopic management of early gastric cancer". Curr Opin Gastroenterol 22 (5): 541-5. PMID 16891887.
^ Novitsky Y, Paton B, Kercher K, Heniford B (2006). "Current aspects of surgical management of GERD". Surg Technol Int 15: 53-62. PMID 17029162.