Barrett esophagus
Barrett esophagus
Updated: 02/14/2022
© Jun Wang, MD, PhD
General
features
- Intestinal metaplasia of distal squamous mucosa
- Incidence higher in whites, males, obese (especially with central adiposity)
- May regress after treatment
- Major risk factor for esophageal adenocarcinoma
Etiology
- Chronic injury, i.e. chronic gastroesophageal reflux
Clinical presentations
- Long history of heartburn and other reflux symptoms
- More massive reflux with more numerous and longer episodes than most reflux patients
Pathological
features
- Erythematous mucosa
- Intestinal metaplasia in gastric-type mucosa above the gastroesophageal junction
- May harbor dysplasia
Low
grade: Minimal glandular architectural distortion, elongated hyperchromic
nuclei in deep glands and surface epithelium
High
grade: Distorted glandular architecture, markedly atypical nuclei
Diagnosis
- Endoscopic examination with biopsy
Treatment
- No dysplasia: follow up
- Low grade
dysplasia: endoscopic eradication, or
endoscopic surveillance annually
- High grade dysplasia:endoscopic therapy, endoscopic surveillance every 3 months for first year, every 6 months for second year, and annually after.
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