Skip to Main Content

++

Essential Features

+

  • • Gastroesophageal reflux disease (GERD)

    • Metaplastic changes from squamous to intestinal-type columnar epithelium in the distal esophagus

    • Metaplasia may contain varying degrees of dysplasia, which is associated with increasing risk of developing esophageal adenocarcinoma

    • Neither medical nor surgical treatment consistently causes regression of metaplastic changes but may prevent progression

++

Epidemiology

+

  • • Acquired intestinal-type metaplasia of any length that replaces the normal squamous epithelium of the distal esophagus; induced by chronic gastroesophageal reflux

    • Found in 10–20% of patients with gastroesophageal reflux

    • Male:female incidence of 2:1; increasing incidence with increased age

    • Conveys a 2-fold increased risk of developing adenocarcinoma

    • Adenocarcinoma is found in 10% of patients with Barrett epithelium at the time of first endoscopic exam

    • Lower esophageal sphincter pressure averages 5 mm Hg; 24-hour pH monitoring reveals increased esophageal acid exposure and impaired clearing

    • Reflux of bile acids may contribute to the development of Barrett esophagus along with acid and pepsin

++

Clinical Findings

++

Symptoms and Signs

+

  • • Heartburn, milder than in the absence of Barrett changes because the metaplastic epithelium is less sensitive than squamous epithelium

    • Regurgitation

    • Dysphagia

++

Imaging Findings

+

  • Esophagoscopy: Pink epithelium in the lower esophagus instead of the shiny gray-pink squamous mucosa; must be verified by biopsy

    Contrast radiography: Hiatal hernia, esophageal stricture, or ulcer

++

Diagnostic Considerations

+

  • • Patients with moderate to severe GERD should undergo endoscopy and biopsy to assess distal esophagus for metaplastic changes

    • Only biopsy proven intestinal-type metaplasia is associated with increased risk of adenocarcinoma

++

Rule Out

+

  • • High-grade dysplasia

    • Adenocarcinoma

++

Work-up

+

  • • Esophagoscopy and biopsy

++

Treatment and Management

+

  • • Treatment is the same as for GERD

    • Surgical treatment is fundoplication

    • Metaplastic epithelium rarely regresses after medical or surgical therapy

++

Surgery

++
Indications
+

  • • Severe GERD refractory to medical treatment

    • Esophageal strictures and ulcers

    • Esophagectomy for high-grade dysplasia

++

Medications

+

  • • H2-blocking agents

    • Proton pump inhibitors

    • Antacids

++

Treatment Monitoring

+

  • • Routine endoscopy and biopsy should be performed every 6–12 months to assess degree of dysplasia

++

Complications

+

  • • Esophageal ulcer

    • Esophageal stricture

    • Esophageal adenocarcinoma

++

Prognosis

+

  • • Estimated incidence of adenocarcinoma in patients with Barrett esophagus of 1:100 patient years of follow-up

++

Prevention

+

  • • Aggressive treatment of GERD

++

Resources

++

References

Chang LC et al: Long-term outcome of esophagectomy for high grade dysplasia or cancer found during surveillance for ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.