Barrett’s Esophagus (BE)



Barrett’s Esophagus (BE)





(Gastroenterol 2006;131:1392-99 & 2005;128:1468-70. Am J. Gastroenterol 2002;97:1888-95)


DEFINITION:



  • Barrett’s esophagus (BE) is displacement of the squamocolumnar junction (SCJ) proximally to the gastroesophageal junction (GEJ) and intestinal metaplasia (IM)



    • Intestinal metaplasia is histologically characterized by acid mucin-containing goblet cells using H & E alcian blue (pH 2.5) stain


  • Short and Long segment BE: Short segment BE <3 cm, Long Segment BE ≥3 cm


  • BE is of little importance if not for the well established association with adenocarcinoma (AC) of the esophagus (BE is a premalignant condition)


  • Note: The endoscopic Prague C & M Criteria (first presented in Prague in 9/2004) has recently been proposed as a standard way of accurately recognizing and grading BE



    • This classification may likely replace the standard ‘Short’ or ‘Long’ segment terminology


EPIDEMIOLOGY:



  • Short segment BE is found 10-15% and Long segment BE is found in 3-7% of symptomatic GERD patients undergoing endoscopy


  • IM of cardia (not BE) can be found in as much as 6-35% of patients undergoing endoscopy for any reason



    • Prevalence increases with age, suggesting an acquired condition; Unlike BE it is found equally in ♂ & ♀ and whites & blacks


  • Reports of up to 25% of BE patients are under the age of 50 – not just an “old person’s disease” (Am J Gastroenterol 2006;101:2187-93)


ETIOLOGIES:



  • Risk factors:



    • Acquired disorder: Age and Duration of reflux (<1 year of symptoms: 4% prevalence; >10 years of symptoms: 21% prevalence)


    • Men > Women; Ethnicity (Caucasian > African American); Obesity; Average age at diagnosis: 63


PATHOPHYSIOLOGY:



  • Acquired condition resulting from severe esophageal mucosal injury; Unclear why some GERD patients get BE and others do not


  • Most BE patients have larger hiatal hernias and lower basal LES pressures (as compared to those with esophagitis or those without reflux)


  • Cyclooxygenase (COX)-2 is involved in chronic inflammation and may be increased by exposure to acid; Possible chemoprevention role in future


  • Evolution of BE [Intestinal metaplasia (IM)] to cancer: Negative for dysplasia » Indefinite for dysplasia » Low-grade dysplasia (LGD) » High-grade dysplasia (HGD) » Adenocarcinoma (AC)



    • Time course variable and most never progress to dysplasia


    • Progression not preordained (i.e. some can go from HGD back to intestinal metaplasia)


CLINICAL MANIFESTATIONS/PHYSICAL EXAM:



  • ± long standing symptoms of GERD

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Aug 24, 2016 | Posted by in GASTROENTEROLOGY | Comments Off on Barrett’s Esophagus (BE)

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