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| Barrett's Esophagus |
| Etiology •Chronic gastroesophageal reflux |
| Pathogenesis •Increased exposure to gastric acid causes peptic esophagitis which when severe enough leads to peptic ulceration of the esophageal mucosa •In the majority of cases repair is through regeneration of esophageal squamous epithelium •In Barrett's, repair is through regeneration of columnar epithelium from pleuripotential basal cells, |
| Epidemiology •See Gastroesophageal reflux(GERD) •The incidence of Barrett's epithelium is 10-20% of patients with reflux esophagitis •In patients with GERD who develop peptic stricture, the incidence of Barrett's is 44% |
| General Gross Description •Barrett's mucosa has a velvety red appearance in contrast to the pale pink-white normal esophageal mucosa •Barrett's is often multifocal, and is seen as irregular patches or tongues of tissue extending proximally, primarily in the distal third of the esophagus •The mucosa of Barrett's is flat, and any plaques or nodular regions are likely to represent the most serious complication of Barrett's, dysplasia or carcinoma |
| General Microscopic Description •The columnar epithelium of Barrett's can resemble either gastric or intestinal mucosa •When it is gastric it can be cardiac or fundal type •When it is intestinal, it can represent incomplete metaplasia with goblet cells and/or Paneth cells being present: or complete metaplasia with both goblet cells, Paneth cells and intestinal absorptive epithelium •When intestinal epithelium is present a diagnosis of Barrett's can be made with confidence •When gastric mucosa is present, the diagnosis of Barrett's esophagus should be reserved for cases where the gastric epithelium is at least 3cm proximal to the anatomic gastoesophageal junction as cardia type mucosa is normally seen in the distal 2-3cm. of the anatomic tubular esophagus |
| Clinical Correlation •There are no specific symptoms specific for Barrett's esophagus •The symptoms are those of longstanding GERD •Reversal of Barrett's has not been generally successful •Current focus is towards fundoplasty or laser removal •Therapy is primarily that of the underlying reflux esophagitis •After the presence of Barrett's has been documented, periodic surveillance for the development of dysplasia should be undertaken, as the incidence of adenocarcinoma in Barrett's is 30X that of the general population |
| References • Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 762-764 |
| Barrett's Esophagus |
| Synopsis by: Martin Nadel, M.D. (T62310M73330)[374] |
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