BARRETT'S ESOPHAGUS

'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. Barrett's esophagus: pathogenesis, epidemiology, functional abnormalities, malignant degeneration, and surgical management, Stein H, Siewert J, , , Dysphagia, 1993 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. The molecular biology of esophageal adenocarcinoma, Koppert L, Wijnhoven B, van Dekken H, Tilanus H, Dinjens W, , , J Surg Oncol, 2005
The condition is named after Dr. Norman Barrett (1903–1979), Australian-born British surgeon at St Thomas' Hospital, who described the condition in 1957. The lower esophagus lined by columnar epithelium, Barrett N, , , Surgery, 1957

Contents

Causes and Symptoms

Pathology

Treatment

References

External links

Causes and Symptoms

Barrett's esophagus is caused by gastroesophageal reflux disease, which allows the stomach's contents to damage the cells lining the lower esophagus. However, not every person who has GERD will develop Barrett's esophagus. Researchers are unable to predict which heartburn sufferers will develop Barrett's esophagus. While there is no relationship between the severity of heartburn and the development of Barrett's esophagus, there is a relationship between chronic heartburn and the development of Barrett's esophagus. Sometimes people with Barrett's esophagus will have no heartburn symptoms at all. In rare cases, damage to the esophagus may be caused by swallowing a corrosive substance such as lye.
The change from normal to premalignant cells that indicates Barrett's esophagus does not cause any particular symptoms. However, warning signs that should not be ignored include:

★ frequent and longstanding heartburn

★ trouble swallowing (dysphagia)

★ vomiting blood

★ pain under the breastbone where the esophagus meets the stomach

★ unintentional weight loss because eating is painful

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. Barrett's oesophagus: from metaplasia to dysplasia and cancer, Fléjou J, , , Gut, 2005
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.
Recent evidence has pointed to a similar condition developing in the distal gut epithelium. Barrett's Anus is a metaplastic change in the distal rectum whose cellularity is similar to that of the gastric mucosa. While the condition is stable for many years, there has been recent evidence to show that it is the predisposing lesion to both anal teratoma and squamous cell carcinoma of the anus. Frequent bouts of steatorrhea are commonly cited as the most likely cause of Barrett's Anus, but much more research needs to be done in order to rule out causes such as HPV 8,13.

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. laser treatment is used in severe dysplasia, while 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. Endoscopic management of early gastric cancer, Reshamwala P, Darwin P, , , Curr Opin Gastroenterol, 2006
Additionally an operation known as a ''Nissen fundoplication'' can reduce the reflux of acid from the stomach into the esophagus. The role of laparoscopic fundoplication in Barrett’s esophagus, Abbas A, Deschamps C, Cassivi SD, et al., , , Annals of Thoracic Surgery, 2004

References

External links

★ Barrett's Esophagus at National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD)

★ Barrett's Info a peer-reviewed web site of information on Barrett's esophagus and its clinical management.

★ Barrett's Esophagus at Johns Hopkins University

★ Barrett's Esophagus Video Overview and Barrett's Esophagus Health Information at Mayo Clinic

★ The Barrett's Oesophagus Foundation The UK charity committed to research into prevention of adenocarcinoma of the oesophagus