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Barrett's esophagus
Classification and external resources
Endoscopic image of Barrett's esophagus, which is the area of red mucosa projecting like a tongue. Biopsies showed intestinal metaplasia.
ICD-10 K22.7
ICD-9 530.85
OMIM 109350
DiseasesDB 1246
MedlinePlus 001143
eMedicine radio/73 

Barrett's esophagus (sometimes called Barrett's syndrome, CELLO, columnar epithelium lined lower oesophagus 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. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings K00-K93 - Diseases of the digestive system (K00-K14 Diseases of oral cavity salivary glands and jaws ( Disorders of Tooth development and Eruption The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. The Mendelian Inheritance in Man project is a Database that catalogues all the known Diseases with a genetic component, and—when possible—links them The Diseases Database is a free Website that provides information about the relationships between medical conditions Symptoms, and Medications. MedlinePlus, with the MedlinePlus Medical Encyclopedia, is a website network containing Health information from the world's largest medical Library eMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely two medical doctors Metaplasia ( Greek: "change in form" is the reversible replacement of one differentiated Cell type with another mature differentiated cell type The esophagus or oesophagus (see American and British English spelling differences) sometimes known as the gullet, is an organ in Esophagitis (or Oesophagitis) is Inflammation of the Esophagus. [1] Barrett's esophagus is found in about 10% of patients who seek medical care for heartburn (gastroesophageal reflux). Gastroesophageal reflux disease ( American English and Canadian English) or Gastro-oesophageal reflux disease ( British English, Hiberno-English It is considered to be a premalignant condition and is associated with an increased risk of esophageal cancer. A premalignant condition is a Disease, Syndrome, or finding that if left untreated may lead to Cancer. Esophageal cancer is malignancy of the Esophagus. There are various subtypes [2]

The condition is named after Dr. Norman Barrett (1903–1979), Australian-born British surgeon at St Thomas' Hospital, who described the condition in 1957. Year 1903 ( MCMIII) was a Common year starting on Thursday (link will display calendar of the Gregorian calendar or a Common year starting Year 1979 ( MCMLXXIX) was a Common year starting on Monday (link displays the 1979 Gregorian calendar) For a topic outline on this subject see List of basic Australia topics. The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom, the UK or Britain,is a Sovereign state located St Thomas' Hospital is a large NHS Hospital in Lambeth, London, England. Year 1957 ( MCMLVII) was a Common year starting on Tuesday (link displays the 1957 Gregorian calendar) [3]

Contents

Causes and Symptoms

Barrett's esophagus is caused by gastroesophageal reflux disease, GERD (UK: GORD), which allows the stomach's contents to damage the cells lining the lower esophagus. However, not every person who has GERD will develop Barrett's esophagus. Researchers are unable to predict which heartburn sufferers will develop Barrett's esophagus. While there is no relationship between the severity of heartburn and the development of Barrett's esophagus, there is a relationship between chronic heartburn and the development of Barrett's esophagus. Sometimes people with Barrett's esophagus will have no heartburn symptoms at all. In rare cases, damage to the esophagus may be caused by swallowing a corrosive substance such as lye. Lye is a Corrosive alkaline substance commonly Sodium hydroxide (NaOH

The change from normal to premalignant cells that indicates Barrett's esophagus does not cause any particular symptoms. However, warning signs that should not be ignored include:

Pathology

Barrett's esophagus is marked by the presence of columnar epithelia in the lower esophagus, replacing the normal squamous cell epithelium—an example of metaplasia. Columnar epithelia are epithelial cells whose heights are at least four times their width In Anatomy, squamous epithelium (from Latin squama, "scale" is an Epithelium characterised by its most superficial layer consisting Metaplasia ( Greek: "change in form" is the reversible replacement of one differentiated Cell type with another mature differentiated cell type The secretory columnar epithelium may be more able to withstand the erosive action of the gastric secretions; however, this metaplasia confers an increased risk of adenocarcinoma. Adenocarcinoma is a cancer that originates in Glandular tissue [4]

The metaplastic columnar cells may be of two types: gastric (similar to those in the stomach, which is NOT technically Barrett's esophagus) or colonic (similar to cells in the intestines). In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following In Anatomy, the intestine is the segment of the alimentary canal extending from the Stomach to the Anus and in humans and other mammals consists A biopsy of the affected area will often contain a mixture of the two. Colonic-type metaplasia is the type of metaplasia associated with risk of malignancy in genetically susceptible people.

The metaplasia of Barrett's esophagus is grossly visible through a gastroscope, but biopsy specimens must be examined under a microscope to determine whether cells are gastric or colonic in nature. A microscope ( Greek: ( micron) = small + ( skopein) = to look or see is an instrument for viewing objects that are Colonic metaplasia is usually identified by finding goblet cells in the epithelium and is necessary for the true diagnosis of Barrett's. Goblet cells are Glandular simple columnar epithelial cells whose sole function is to secrete Mucus.

There are many histologic mimics of Barrett's esophagus (i. e. goblet cells occurring in the transitional epithelium of normal esophageal submucosal gland ducts, "pseudogoblet cells" in which abundant foveolar (gastric) type mucin simulates the acid mucin true goblet cells). Assessment of relationship to submucosal glands and transitional-type epithelium with examination of multiple levels through the tissue may allow the pathologist to reliably distinguish between goblet cells of submucosal gland ducts and true Barrett's esophagus (specialized columnar metaplasia). Use of the histochemical stain Alcian blue pH 2. 5 is also frequently used to distinguish true intestinal-type mucins from their histologic mimics. Recently, immunohistochemical analysis with antibodies to CDX-2 (specific for mid and hindgut intestinal derivation) has also been utilized to identify true intestinal-type metaplastic cells.

After the initial diagnosis of Barrett's esophagus is rendered, affected persons undergo annual surveillance to detect changes that indicate higher risk to progression to cancer: development of dysplasia. There is considerable variability in assessment for dysplasia among pathologists. Recently, gastroenterology and GI pathology societies have recommended that any diagnosis of high grade dysplasia in Barrett's be confirmed by at least two fellowship trained GI pathologists prior to definitive treatment for patients.

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. Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an instrument called an endoscope. A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues Dysplasia (from Greek roughly "bad formation" is a term used in Pathology to refer to an abnormality in maturation of cells within a tissue Proton pump inhibitors (or "PPI"s are a group of drugs whose main action is pronounced and long-lasting reduction of Gastric acid production Proton pump inhibitor drugs have not yet been proven to prevent esophageal cancer. Laser treatment is used in severe dysplasia, while overt malignancy may require surgery, radiation therapy, or systemic chemotherapy. Laser surgery is Surgery using a Laser to cut tissue instead of a Scalpel. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Radiation therapy (or radiotherapy) is the medical use of Ionizing radiation as part of Cancer treatment to control Malignant Chemotherapy, in its most general sense refers to treatment of disease by chemicals that kill cells specifically those of micro-organisms or Cancer. Additionally, a recent 5-year random-controlled trial has shown that photodynamic therapy using photofrin is statistically more effective in eliminating dysplastic growth areas than sole use of a proton pump inhibitor. Photodynamic therapy (PDT matured as a feasible medical technology in the 1980s at several institutions throughout the world is a third-level treatment for Cancer involving [5]There is presently no reliable way to determine which patients with Barrett's esophagus will go on to develop esophageal cancer, although a recent study found that the detection of three different genetic abnormalities were associated with as much as a 79% chance of developing cancer in 6 years. [6] Endoscopic mucosal resection (EMR) has also been evaluated as a management technique. [7]

Additionally an operation known as a Nissen fundoplication can reduce the reflux of acid from the stomach into the esophagus. Nissen fundoplication is a Surgical procedure to treat Gastroesophageal reflux disease (GERD and Hiatus hernia. [8]

In a variety of studies, non-steroidal anti-inflammatory drugs (NSAIDS), like aspirin, have shown evidence of preventing esophageal cancer in Barrett's esophagus patients. Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAID s or NAID s, are drugs with Analgesic, Antipyretic and in higher Aspirin, or acetylsalicylic acid (ASA (əˌsɛtɨlsælɨˌsɪlɨk ˈæsɨd is a Salicylate drug, often used as an Analgesic to relieve [9][10] However, none of these studies have been randomized, placebo controlled trials, which are considered the gold standard for evaluating a medical intervention. A randomized controlled trial (RCT is a type of scientific Experiment most commonly used in testing the Efficacy or Effectiveness of Healthcare In addition, the best dose of NSAIDs for cancer prevention is not yet known.

References

  1. ^ Stein H, Siewert J (1993). "Barrett's esophagus: pathogenesis, epidemiology, functional abnormalities, malignant degeneration, and surgical management". Dysphagia 8 (3): 276-88. doi:10.1007/BF01354551. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 8359051.  
  2. ^ Koppert L, Wijnhoven B, van Dekken H, Tilanus H, Dinjens W (2005). "The molecular biology of esophageal adenocarcinoma". J Surg Oncol 92 (3): 169-90. doi:10.1002/jso.20359. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16299787.  
  3. ^ Barrett N (1957). "The lower esophagus lined by columnar epithelium". Surgery 41 (6): 881-94. PMID 13442856.  
  4. ^ Fléjou J (2005). "Barrett's oesophagus: from metaplasia to dysplasia and cancer". Gut 54 Suppl 1: i6-12. PMID 15711008.  
  5. ^ Overholt BF, Wang KK, Burdick JS, et al. (2007). "Five-year efficacy and safety of photodynamic therapy with Photofrin in Barrett's high-grade dysplasia. ". Gastrointestinal endoscopy 66 (3): 460-8. PMID 17643436.  
  6. ^ Galipeau P, Li X, Blount PL, Maley CC, Sanchez CA Odze RD, Ayub K, Rabinovitch PS, Vaughan TV, Reid BJ (2007). "NSAIDs modulate CDKN2A, TP53, and DNA content risk for progression to esophageal adenocarcinoma" 4 (2): e67. PMID 17326708.  
  7. ^ Reshamwala P, Darwin P (2006). "Endoscopic management of early gastric cancer". Curr Opin Gastroenterol 22 (5): 541-5. doi:10.1097/01.mog.0000239870.04457.80. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16891887.  
  8. ^ Abbas A, Deschamps C, Cassivi SD, et al. (2004). "The role of laparoscopic fundoplication in Barrett’s esophagus". Annals of Thoracic Surgery 77 (2): 393-396. doi:10.1016/S0003-4975(03)01352-3. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 14759403.  
  9. ^ Corley DA, Kerlikowske K, Verma R, Buffler P (2003). "Protective association of aspirin/NSAIDs and esophageal cancer: a systematic review and meta-analysis. ". Gastroenterology 124: 47-56. doi:10.1053/gast.2003.50008. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 12512029.  
  10. ^ Vaughan TL, Dong LM, Blount PL, Ayub K, Odze RD, Sanchez, CA, Rabinovitch PS, Reid BJ (2005). "Non-steroidal anti-inflammatory drugs and risk of neoplastic progression in Barrett's oesophagus: a prospective study". Lancet Oncol 6: 945-52. doi:10.1016/S1470-2045(05)70431-9. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 16321762.  

External links

Mayo Clinic is a Non-profit medical practice Its headquarters the Mayo Medical School and its research facilities are in Rochester Minnesota in

Dictionary

Barrett's esophagus

-noun

  1. (US, pathology) 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.
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