Gastroenterology Book

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Barrett's Esophagus

Aka: Barrett's Esophagus, Barrett's Metaplasia
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  1. See Also
    1. Gastroesophageal Reflux Disease
    2. Esophageal Adenocarcinoma
  2. Pathophysiology
    1. Columnar metaplasia of distal esophagus
    2. Response to chronic inflammation
      1. Gastroesophageal Reflux
  3. Risk Factors
    1. Gastroesophageal Reflux
      1. GERD Symptoms > 3x/week for 20 years: RR = 40
    2. Racial predisposition
      1. Caucasian
      2. Hispanic
    3. Older age
    4. Tobacco Abuse (2 fold increase in Esophageal Cancer)
    5. Male gender
    6. Obesity
  4. Evaluation: Endoscopy
    1. Indications for screening for Barrett's Esophagus
      1. Significant risk factors above
      2. Red flag symptoms
        1. Dysphagia
        2. Odynaphagia
        3. Upper Gastrointestinal Bleeding
        4. Weight loss
    2. Surveillance and management protocol (controversial)
      1. Consider screening only once in patients with GERD
      2. Barrett's Esophagus without dysplasia
        1. Repeat endoscopy with biopsy in one year
        2. If no dysplasia x2 biopsies, then endoscopy every 3 years
      3. Low grade dysplasia
        1. Repeat endoscopy with biopsy in 6 months
        2. Then repeat upper endoscopy annually until no dysplasia on 2 biopsies (and then endoscopy every 3 years)
      4. High grade dysplasia
        1. Repeat upper endoscopy every 3 months
        2. Consider esophagectomy if able to undergo surgery
        3. Consider endoscopic resection and ablation if not able to undergo surgery
    3. Findings consistent with Barrett's Esophagus
      1. Z-line is squamocolumnar junction
        1. Z-Line is normally at gastroesophageal junction
      2. Barrett's Esophagus
        1. Z-line shifts up from gastroesophageal junction
        2. Long-segment Barrett's: >3 cm from junction
        3. Short-segment Barrett's: <3 cm from junction
    4. Screening difficulties
      1. Esophageal Cancer is uncommon, even in Barrett's
      2. Most Esophageal Cancer patients have no GERD symptoms
      3. Longterm surveillance is still recommended
      4. References
        1. Gopal (2002) Evid Based Oncol 3(4):144-5
        2. Hage (2004) Scand J Gastroenterol 39:1175-9
  5. Management: Radiofrequency Ablation
    1. Preliminary evidence for ablation is very promising
  6. Prognosis: Endoscopy factors predicting low risk of adenocarcinoma
    1. Low grade or no dysplasia on initial endoscopy and
    2. Barrett's Esophagus length <6 cm
    3. Weston (2004) Am J Gastroenterol 99:1657-66
  7. Complications of Barrett's Esophagus
    1. Esophageal Adenocarcinoma
      1. Cancer Incidence on first endoscopy: 0.5% per year
  8. References
    1. Kahrilas in Feldman (2002) Sleisenger GI, p. 615-8
    2. Katzka (2003) Hematol Oncol Clin North Am 17(2):471
    3. Spechler (2002) N Engl J Med 346:836-42

Barrett Esophagus (C0004763)

Definition (NCI) Esophageal lesion lined with columnar metaplastic epithelium which is flat or villiform. Barrett epithelium is characterized by two different types of cells: goblet cells and columnar cells. The symptomatology of Barrett esophagus is that of gastro-esophageal reflux. It is the precursor of most esophageal adenocarcinomas. (WHO)
Definition (MSH) A condition with damage to the lining of the lower ESOPHAGUS resulting from chronic acid reflux (ESOPHAGITIS, REFLUX). Through the process of metaplasia, the squamous cells are replaced by a columnar epithelium with cells resembling those of the INTESTINE or the salmon-pink mucosa of the STOMACH. Barrett's columnar epithelium is a marker for severe reflux and precursor to ADENOCARCINOMA of the esophagus.
Definition (CSP) syndrome including peptic ulcer of the lower esophagus, often with stricture, due to the presence of columnar lined epithelium, which may contain functional mucous cells, parietal cells, or chief cells in the esophagus instead of normal squamous cell epithelium; sometimes pre-malignant, followed by esophageal adenocarcinoma.
Definition (NCI) A condition in which the cells lining the lower part of the esophagus have changed or been replaced with abnormal cells that could lead to cancer of the esophagus. The backing up of stomach contents (reflux) may irritate the esophagus and, over time, cause Barrett's esophagus.
Concepts Disease or Syndrome (T047)
MSH D001471
ICD9 530.85
ICD10 K22.7, K22.70
SnomedCT 235597001, 155679007, 76355008, 196609006, 302914006, 196603007
English Esophagus, Barrett, BARRETT'S ESOPHAGUS, ESOPHAGUS, BARRETT, ESOPHAGUS, COLUMNAR-LINED, Barrett's Esophagitis, Syndrome, Barrett's, CELLO - Col epith-lin low oeso, CLE - Columnar-lined oeso, Columnar epith-lined low oeso, Barrett's esophagitis, BARRETT ESOPHAGUS, BO - Barrett's esophagus, Barrett's Esophagus, Barretts Esophagus, Esophagus, Barrett's, Barrett Syndrome, Barrett's Syndrome, Barretts Syndrome, Syndrome, Barrett, Barrett's esophagus (diagnosis), barrett's esophagus, Barrett's oesophagus (disorder), Barrett's oesophagitis, ESOPHAGUS BARRETT, Barrett esophagus, Barrett Esophagus [Disease/Finding], barrett's esophagitis, barretts syndrome, barrett's oesophagitis, barrett's oesophagus, barrett esophagus, barrett's syndrome, barrett syndrome, barrett oesophagitis, barrett esophagitis, Barretts esophagus, Barretts syndrome, Barrett's esophagus NOS, Barrett's disease, Endobrachyoesophagus, Endobrachyooesophagus, Columnar-lined esophagus, Barrett's esophagus, Barrett's syndrome, Gastric metaplasia of esophagus, Barrett's oesophagus, Columnar-lined oesophagus, Gastric metaplasia of oesophagus, BO - Barrett's oesophagus, CELLO - Columnar epithelial-lined lower esophagus, CELLO - Columnar epithelial-lined lower oesophagus, CLE - Columnar-lined esophagus, CLE - Columnar-lined oesophagus, Columnar epithelial-lined lower esophagus, Columnar epithelial-lined lower oesophagus, Barrett's esophagus (disorder), Barrett, Barrett's esophagus (disorder) [Ambiguous], Barrett Esophagus, BE, Columnar Epithelial-Lined Lower Esophagus, Columnar-Lined Esophagus, CELLO, CLE, Esophagitis;Barretts, Oesophagitis;Barretts, Barretts esophagitis, Barretts oesophagitis
Dutch Barret-oesophagus, endobrachyoesophagus, Barrett-oesophagitis, Barrett-oesophagus, Barrett-oesofagus, Barrett-syndroom, Oesofagus, Barrett-
French Oesophagite de Barrett, Endobrachyoesophage, Endo-brachy-oesophage de Barrett, Endobrachy-oesophage de Barrett, Oesophage de Barrett (diagnostic), Oesophage de Barrett, Syndrome de Barrett
German Barrett-Oesophagitis, Endobrachyoesophagus, Barrett-Ulkus, Barrett-Syndrom, Barrett-Ösophagus, Ösophagus, Barrett-
Italian Endobrachiesofago, Esofagite di Barrett, Sindrome di Barrett, Esofago di Barrett (diagnosi), Esofago di Barrett
Portuguese Endobraquiesófago, Esofagite de Barrett, Esófago de Barrett, Esôfago de Barrett, Síndrome de Barrett
Spanish Endobraquioesófago, Esofagitis de Barrett, Barrett's oesophagus, Barrett's esophagus, síndrome de Barret, epitelio columnar en el esófago distal, esófago con epitelio columnar, esófago de Barret (concepto no activo), esófago de Barret (trastorno), esófago de Barret, metaplasia gástrica de esófago, metaplasia gástrica del esófago, síndrome de Barrett, esófago de Barret [dup] (trastorno), Esofago de Barrett, Esófago de Barrett, Síndrome de Barrett, Sindrome de Barrett
Japanese 食道円柱上皮化, ﾊﾞﾚｯﾄｼｮｸﾄﾞｳ, ｼｮｸﾄﾞｳｴﾝﾁｭｳｼﾞｮｳﾋｶ, Barrett食道, Barrett症候群, バレット食道, バレット症候群, 食道-バレット
Swedish Barretts esofagus
Czech Barrettův ezofágus, Endobrachyezofagus, Barretův jícen
Finnish Barrettin ruokatorvi
Russian BARRETA PISHCHEVOD, PISHCHEVOD BARRETA, БАРРЕТА ПИЩЕВОД, ПИЩЕВОД БАРРЕТА
Korean 바렛 식도
Polish Wrzód trawienny przełyku, Przełyk Barretta
Hungarian Barrett oesophagitis, Endobrachyoesophagus, Barrett-oesophagus, Barrett oesophagus
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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