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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 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 condition is named after Dr. Norman Barrett (1903–1979), Australian-born
British surgeon at St Thomas' Hospital, who described the condition in 1957.
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 has also been evaluated for "Barrett's" management.
Additionally an operation known as a Nissen fundoplication can reduce the reflux
of acid from the stomach into the esophagus.
Pathology:
Barrett's esophagus is
marked by the presence of columnar cell epithelium 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.
The metaplastic columnar cells may be of two types: gastric (similar to
those in the stomach) 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.
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Endoscopic image of Barrett's esophagus, which is the area of red mucosa
projecting like a tongue. Biopsies showed intestinal metaplasia
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Retrieved from "http://en.wikipedia.org/wiki/Barrett%27s_esophagus
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