11.01.08
Barrett Esophagus
Barrett’s Esophagus
-premalignant condition in which abnormal columnar epithelium replaces the
stratified squamous epithelium that normally lines the distal esophagus -most severe histologic consequence of chronic gastroesophageal reflux -predisposes to the development of adenocarcinoma of the esophagus
Epidemiology- usually discovered during endoscopy -mean age of diagnosis is 55 years; 3M>F -can affect children, but rarely before age 5 (and thus supports an acquired
condition vs. a congenital one) -10-15% Barrett’s are found during endoscopy for symptoms of GERD -uncommon in African Americans and Asians -prevalence in Hispanics is similar to Caucasians -prevalence in the general population is variable -risk factors: male, white, smoker
Clinical Features- columnar metaplasia in Barrett’s esophagus causes no symptoms -most patients are seen initially for symptoms of GERD (heartburn, regurgitation, dysphagia) -GERD associated with Barrett’s esophagus is frequently complicated by esophageal ulceration/perforation, stricture, shortening and hemorrhage -histologically, 3 different types of columnar epithelia in Barrett’s: -specialized intestinal metaplasia (villiform surface and intestinal-type
crypts lined by mucous-secreting columnar cells and goblet cells -gastric fundic-type epithelium -junctional-type epithelium
-specialized intestinal metaplasia is the most common, and likely associated with dysplasia and carcinoma
Diagnosis- sensitivity of endoscopy in detecting Barrett’s is related to the length of
involved mucosa (long segment Barrett’s) -overall reliability of endoscopy for detection of Barrett’s is ~ 80% -controversy regarding diagnostic criteria for Barrett’s (no reproducible anatomic
landmarks that clearly delimit the esophagus-GEJ or squamocolumnar junction)
-3 terms describing the specialized intestinal metaplasia in the esophagus: -long segment Barrett’s (range 2-5 cm, but 3 cm is the accepted cutoff) -short segment Barrett’s (less than 3 cm), more prevalent -junctional intestinal metaplasia (squamocolumnar junction=GEJ)
-long segment has a higher risk of dysplasia and adenocarcinoma
Treatment- endoscopic surveillance is the current recommendation -reflux control with antireflux procedure to prevent mucosal damage prn -if confirmed high grade dysplasia or cancer, esophagectomy is recommended -other procedures with less success: laser ablation, photodynamic therapy,
mucosectomy, argon plasma coagulation
