Barrett's esophagus

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Barrett's esophagus
Barrett's esophagus as seen on endoscopy
Synonyms	Barrett's syndrome, columnar epithelium lined lower esophagus (CELLO)
Pronounce	N/A
Specialty	N/A
Symptoms	Heartburn, regurgitation, dysphagia
Complications	Esophageal adenocarcinoma
Onset	Typically in adults over 50
Duration	Long-term
Types	N/A
Causes	Gastroesophageal reflux disease (GERD)
Risks	Smoking, obesity, male gender, Caucasian ethnicity
Diagnosis	Endoscopy with biopsy
Differential diagnosis	Esophagitis, esophageal stricture
Prevention	Managing GERD, lifestyle changes
Treatment	Proton pump inhibitors, endoscopic surveillance, esophagectomy in severe cases
Medication	N/A
Prognosis	Variable; risk of cancer
Frequency	Affects 1.6% to 6.8% of adults
Deaths	N/A

Barrett's esophagus is a condition in which the cells of the esophageal lining undergo metaplastic change and resemble cells found in the intestines. This condition is typically caused by chronic gastroesophageal reflux disease (GERD), in which stomach contents frequently back up into the esophagus, irritating and damaging the esophageal lining.

Histopathology of Barrett's esophagus, annotated

Pathophysiology

The underlying cause of Barrett's esophagus is thought to be an adaptation to chronic acid exposure from reflux esophagitis. Damaged squamous cells are replaced by columnar cells better suited to handle an acidic environment.

Barrett's mucosa, higher magnification, Alcian blue stain

Diagnosis

Barrett's esophagus is diagnosed using endoscopy to directly visualize the esophagus, and biopsy to examine the cells under a microscope.

Symptoms

Many individuals with Barrett's esophagus have no symptoms. Those who do have symptoms typically have long-standing GERD, with symptoms including heartburn, regurgitation, and difficulty swallowing.

Treatment

The goal of treatment in Barrett's esophagus is to relieve symptoms of GERD, prevent further damage by reducing stomach acid, and monitor for precancerous changes.

• Medications: Proton pump inhibitors (PPIs) are commonly used to decrease the production of stomach acid.
• Endoscopic procedures: These can be used to destroy the Barrett's tissue, promoting the growth of normal esophageal cells.
• Surgery: In severe cases, or when precancerous cells are found, part of the esophagus may be removed.

Prognosis

Patients with Barrett's esophagus have an increased risk of developing esophageal adenocarcinoma, a type of cancer. Regular surveillance through endoscopy and biopsy is often recommended.

See Also

• Gastroesophageal reflux disease
• Endoscopy
• Biopsy
• Esophageal cancer

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