Barrett's Esophagus

BARRETT'S ESOPHAGUS
  • It is a pre-malignant condition.
  • Metaplasia of esophageal squamous epithelium into columnar in distal esophagus
  • It is consequence of severe reflux esophagitis
  • MC type of columnar epithelium is intestinal epithelium (Intestinal metaplasia)
  • Columnar epithelium in Barrett's esophagus
  1. Intestinal type: MC type, most commonly associated with dysplasia and carcinoma
  2. Junctional type
  3. Fundic type
  • Metaplasia characteristically affects distal esophagus
  • More common in men, whites and with increasing age
  • Usually there are no particular severe symptoms, although they do have the most abnormal pH profiles.
  • Barrett’s esophagus can be classified into long segment( involvement of >3 cm of esophagus) and short segment disease ( involvement of < 3 cm of esophagus).
  1. Long segment disease carries more risk for adenocarcinoma.
  • Can lead to chronic peptic ulceration of esophagus (Barrett's ulcer)
  • Can lead to high (midesophageal) and long strictures.
  • Barrett's esophagus does not responds to conservative management.
INVESTIGATIONS IN A CASE OF BARRETT'S ESOPHAGUS
  • Methylene Blue dye is used in a patient of Barrett's esophagus undergoing chromoendoscopy for detection of cancer.
  • A screening endoscopy for Barrett's esophagus may be considered in patients with a chronic history (>10 year) of GERD symptoms.
  • Frequent esophagoscopy is needed in people with Barrett’s esophagus as it doesn’t regress.
  • Endoscopic biopsy is the gold standard for confirmation of Barrett's esophagus.
  • Barrett's esophagus requires both endoscopically visible segment of columnar lining of distal esophagus and intestinal metaplasia showing goblet cells on biopsy
  • The classification system used for barrett's esophagus is Prague.
Exam Question of:
  • Barrett's esophagus is Columnar metaplasia /Intestinal metaplasia.
  • Barrett's Esophagus is a pre-malignant condition.
  • Barrett's esophagus leads to Adenocarcinoma.
  • Chronic reflux is a casue of Barrett's Esophagus.
  • Established metaplasia doesn’t reverse in a case of Barrett's Esophagus.
  • Barrett's Esophagus is more common in men.
  • Long esophageal segment is involved in Barrett's Esophagus.
  • Barrett's esophagus does not lead to Odynophagia.
  • Methylene Blue dye is used in a patient of Barrett's esophagus undergoing chromoendoscopy for detection of cancer.
  • A screening endoscopy for Barrett's esophagus may be considered in patients with a chronic history (>10 year) of GERD symptoms. 
  • Endoscopic biopsy is the gold standard for confirmation of Barrett's esophagus.
  • The classification system used for barrett's esophagus is Prague.
  • In Barrett's esophagus, esophageal lining is changed to Columnar epithelium.
  • Barrett's esophagus is lower oesophagus lined by columnar epithelium.
  • Barrett's esophagus can lead to Stricture and Peptic ulcer.
  • Barrett's esophagus is more common in males.
  • Barrett's esophagus does not responds to conservative management.
  • Patient is usually asymptomatic in a case of Barrett's Esophagus.
  • Histology of the lesion in a case of Barrett's esophagus shows mucus secreting goblet cells.
  • Diagnosis of Barrett's esophagus is made by demons­tration of columnar mucosa, which on histopathology shows Intestinal type of metaplasia.

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