| Barrett esophagus | |
|---|---|
| Other names | Barrett's oesophagus, Allison-Johnstone anomaly, columnar epithelium lined lower oesophagus (CELLO) |
 | |
| Endoscopic image of Barrett's esophagus, which is the area of dark reddish-brown mucosa at the base of the esophagus. | |
| Specialty | Gastroenterology, general surgery |
| Symptoms | Heartburn, acid reflux[1] |
| Complications | Esophageal adenocarcinoma[1] |
| Types | No dysplasia, low-grade dysplasia, high-grade dysplasia, invasive adenocarcinoma[1] |
| Causes | Gastroesophageal reflux disease[1] |
| Diagnostic method | Endoscopy, tissue biopsy[1] |
| Differential diagnosis | Gastritis, esophageal spasm, Helicobacter pylori infection, gallstones, heart disease[1] |
| Treatment | Surveillance, ablation, resection[1] |
| Medication | Proton pump inhibitor[1] |
| Frequency | 1.5%[1] |
Barrett esophagus (BE) is an abnormal change of the cells lining the lower portion of the esophagus from squamous epithelium to columnar epithelium.[1] Though it does not result in symptoms itself, associated symptoms may include heartburn, acid reflux, and trouble swallowing.[1][2] It is precancerous condition in which less than 5% develop esophageal adenocarcinoma.[3][1]
The underlying mechanism is thought to be adaptation to long term acid exposure due to gastroesophageal reflux disease (GERD).[1] Some cases may also run in families.[1] Risk factors include hiatal hernia, pregnancy, obesity, asthma, diabetes, and peptic ulcer disease.[1] It is classified into four types: nondysplastic, low-grade dysplasia, high-grade dysplasia, and invasive adenocarcinoma.[1] Testing for the condition is recommended in males who have symptoms for more than five years along with other risk factors.[1] Diagnosis is confirmed by seeing the characteristic appearance on endoscopy and tissue biopsy.[1]
Treatment is generally with a proton pump inhibitor with further efforts depending on the type.[1][4] When no dysplasia is present surveillance is recommended every 3 to 5 years.[1] For low-grade dysplasia surveillance every 6 to 12 months or endoscopic ablation is recommended.[1] For high-grade dysplasia treatment is with resection of the involve mucosa followed by ablation.[1] If the mucosa looks normal but the biopsy is concerning radiofrequency ablation is recommended.[1][5] If cancer is present surgery may be recommended.[1]
About 1.5% of the general population and 10% of people with GERD are effected.[1] The average age at diagnosis is 55.[6] Males are effected more often than females.[1] The condition may have been initially described in 1879 by Heinrich Quinke and 1906 by Wilder Tileston.[7] Further descriptions occurred in 1950 by the surgeon Norman Barrett, after who it is named.[8]
References edit
- ^ a b c d e f g h i j k l m n o p q r s t u v w x y z Khieu, M; Mukherjee, S (January 2020). "Barrett Esophagus". PMID 28613697.
{{cite journal}}: Cite journal requires|journal=(help) - ^ "Symptoms & Causes of Barrett's Esophagus | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Archived from the original on 17 October 2020. Retrieved 15 November 2020.
- ^ Shaheen NJ, Richter JE (March 2009). "Barrett's oesophagus". Lancet. 373 (9666): 850–61. doi:10.1016/S0140-6736(09)60487-6. PMID 19269522. S2CID 13141959.
- ^ "Treatment for Barrett's Esophagus | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Archived from the original on 16 October 2020. Retrieved 15 November 2020.
- ^ Shaheen, Nicholas J.; Falk, Gary W.; Iyer, Prasad G.; Gerson, Lauren B.; American College of Gastroenterology (January 2016). "ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus". The American Journal of Gastroenterology. 111 (1): 30–50, quiz 51. doi:10.1038/ajg.2015.322. ISSN 1572-0241. PMID 26526079. S2CID 2274838.
- ^ "Definition & Facts for Barrett's Esophagus | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Archived from the original on 16 October 2020. Retrieved 15 November 2020.
- ^ Yeo, Charles J.; McFadden, David W.; Pemberton, John H.; Peters, Jeffrey H.; Matthews, Jeffrey B. (2012). Shackelford's Surgery of the Alimentary Tract E-Book. Elsevier Health Sciences. p. 283. ISBN 978-1-4557-3807-6. Archived from the original on 2021-08-27. Retrieved 2020-11-15.
- ^ Shields, Thomas W.; LoCicero, Joseph; Reed, Carolyn E.; Feins, Richard H. (2009). General Thoracic Surgery. Lippincott Williams & Wilkins. p. 1925. ISBN 978-0-7817-7982-1. Archived from the original on 2021-08-27. Retrieved 2020-11-15.