Barrett's esophagus

Barrett's esophagus
Barrett's esophagus
Other names	Barrett's oesophagus, Allison-Johnstone anomaly, columnar epithelium lined lower oesophagus (CELLO)
	Endoscopic image of Barrett's esophagus, which is the area of dark reddish-brown mucosa at the base of the esophagus. (Biopsies showed intestinal metaplasia.)
Specialty	Gastroenterology; General surgery
Symptoms	Nausea

Barrett's esophagus is a condition in which there is an abnormal (metaplastic) change in the mucosal cells lining the lower portion of the esophagus, from stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells that are normally present only in the small intestine and large intestine. This change is considered to be a premalignant condition because of its potential to further transition to esophageal adenocarcinoma, an often-deadly cancer.^[1]^[2]

The main cause of Barrett's esophagus is thought to be an adaptation to chronic acid exposure from reflux esophagitis.^[3] Barrett's esophagus is diagnosed by endoscopy: observing the characteristic appearance of this condition by direct inspection of the lower esophagus; followed by microscopic examination of tissue from the affected area obtained from biopsy. The cells of Barrett's esophagus are classified into four categories: nondysplastic, low-grade dysplasia, high-grade dysplasia, and frank carcinoma. High-grade dysplasia and early stages of adenocarcinoma may be treated by endoscopic resection or radiofrequency ablation.^[4] Later stages of adenocarcinoma may be treated with surgical resection or palliation. Those with nondysplastic or low-grade dysplasia are managed by annual observation with endoscopy, or treatment with radiofrequency ablation. In high-grade dysplasia, the risk of developing cancer might be at 10% per patient-year or greater.^[1]

The incidence of esophageal adenocarcinoma has increased substantially in the Western world in recent years.^[1] The condition is found in 5–15% of patients who seek medical care for heartburn (gastroesophageal reflux disease, or GERD), although a large subgroup of patients with Barrett's esophagus are asymptomatic. The condition is named after surgeon Norman Barrett (1903–1979) even though the condition was originally described by Philip Rowland Allison in 1946.^[5]^[6]^[7]

^ ^a ^b ^c Shaheen NJ, Richter JE (March 2009). "Barrett's oesophagus". Lancet. 373 (9666): 850–61. doi:10.1016/S0140-6736(09)60487-6. PMID 19269522. S2CID 13141959.
^ Koppert LB, Wijnhoven BP, van Dekken H, Tilanus HW, Dinjens WN (December 2005). "The molecular biology of esophageal adenocarcinoma". Journal of Surgical Oncology. 92 (3): 169–90. doi:10.1002/jso.20359. PMID 16299787. S2CID 42893278.
^ Stein HJ, Siewert JR (1993). "Barrett's esophagus: pathogenesis, epidemiology, functional abnormalities, malignant degeneration, and surgical management". Dysphagia. 8 (3): 276–88. doi:10.1007/BF01354551. PMID 8359051. S2CID 6715044.
^ Shaheen, Nicholas J.; Falk, Gary W.; Iyer, Prasad G.; Gerson, Lauren B.; American College of Gastroenterology (January 2016). "ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus". The American Journal of Gastroenterology. 111 (1): 30–50, quiz 51. doi:10.1038/ajg.2015.322. ISSN 1572-0241. PMC 10245082. PMID 26526079. S2CID 2274838.
^ Allison PR (March 1948). "Peptic ulcer of the oesophagus". Thorax. 3 (1): 20–42. doi:10.1136/thx.3.1.20. PMC 1018255. PMID 18904843.
^ Cite error: The named reference Bani-Hani was invoked but never defined (see the help page).
^ Katz-Summercorn, Annalise C.; Frankell, Alexander M.; Fitzgerald, Rebecca C. (2016). "Chapter 4: Genetics and Biomarkers in Barrett's Esophagus and Esophageal Adenocarcinoma". In Pleskow, Douglas K.; Erim, Tolga (eds.). Barrett's Esophagus - Emerging Evidence for Improved Clinical Practice. pp. 37–60. doi:10.1016/B978-0-12-802511-6.00004-1. ISBN 9780128025116.

[pmid19269522-1] Shaheen NJ, Richter JE (March 2009). "Barrett's oesophagus". Lancet. 373 (9666): 850–61. doi:10.1016/S0140-6736(09)60487-6. PMID 19269522. S2CID 13141959.

[Koppert_2005-2] Koppert LB, Wijnhoven BP, van Dekken H, Tilanus HW, Dinjens WN (December 2005). "The molecular biology of esophageal adenocarcinoma". Journal of Surgical Oncology. 92 (3): 169–90. doi:10.1002/jso.20359. PMID 16299787. S2CID 42893278.

[Stein_1993-3] Stein HJ, Siewert JR (1993). "Barrett's esophagus: pathogenesis, epidemiology, functional abnormalities, malignant degeneration, and surgical management". Dysphagia. 8 (3): 276–88. doi:10.1007/BF01354551. PMID 8359051. S2CID 6715044.

[4] Shaheen, Nicholas J.; Falk, Gary W.; Iyer, Prasad G.; Gerson, Lauren B.; American College of Gastroenterology (January 2016). "ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus". The American Journal of Gastroenterology. 111 (1): 30–50, quiz 51. doi:10.1038/ajg.2015.322. ISSN 1572-0241. PMC 10245082. PMID 26526079. S2CID 2274838.

[Peptic_ulcer_of_the_oesophagus-5] Allison PR (March 1948). "Peptic ulcer of the oesophagus". Thorax. 3 (1): 20–42. doi:10.1136/thx.3.1.20. PMC 1018255. PMID 18904843.

[Bani-Hani-6] Cite error: The named reference Bani-Hani was invoked but never defined (see the help page).

[7] Katz-Summercorn, Annalise C.; Frankell, Alexander M.; Fitzgerald, Rebecca C. (2016). "Chapter 4: Genetics and Biomarkers in Barrett's Esophagus and Esophageal Adenocarcinoma". In Pleskow, Douglas K.; Erim, Tolga (eds.). Barrett's Esophagus - Emerging Evidence for Improved Clinical Practice. pp. 37–60. doi:10.1016/B978-0-12-802511-6.00004-1. ISBN 9780128025116.

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