Barrett’s Esophagus - Overview from the National Digestive Diseases Information Clearinghouse
Barrett’s esophagus is a condition in which the tissue lining the esophagus—the muscular tube that connects the mouth to the stomach—is replaced by tissue that is similar to the lining of the intestine. This process is called intestinal metaplasia. No signs or symptoms are associated with Barrett’s esophagus, but it is commonly found in people with gastroesophageal reflux disease (GERD). A small number of people with Barrett’s esophagus develop a rare but often deadly type of cancer of the esophagus. Barrett’s esophagus affects about 1 percent1 of adults in the United States. Read more at the National Digestive Diseases Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.
Information on Barrett's Esophagus at The Society of Thoracic Surgeons
The esophagus is a muscular tube that extends from the neck to the abdomen and connects the back of the throat to the stomach. Its inner lining, or mucosa, normally consists of flat cells (known as squamous cells) that are similar to those of the skin. When this squamous cell lining is replaced by other cells that have a more cube-like shape, the condition is known as Barrett's esophagus or the columnar-lined esophagus, referring to cells that are shaped like a column. When Barrett's esophagus is present, the columnar lining extends from the junction of the esophagus and stomach upwards into the esophagus for a variable distance ranging from a few millimeters to nearly the entire length of the esophagus...Read more at The Society of Thoracic Surgeons
Information on Barrett's Esophagus at the American College of Gastroenterology
In order to understand Barrett’s esophagus it is useful to understand the normal appearance of the esophagus. In the normal esophagus, the tissue lining appears pale pink and smooth. These flat square cells, called ‘squamous’ (Latin for square) cells, make up the normal lining of the esophagus. See cartoons 1 and 2...Go to the American College of Gastroenterology.
Podcast: Esophageal Cancer/Barrett's Esophagus
Dr. Bruce Greenwald, a gastroenterologist at the University of Maryland Medical Center and a professor of medicine at the University of Maryland School of Medicine, says that GERD also can cause Barrett’s esophagus - changes in the esophageal lining caused by stomach acid that can become cancerous. Listen to the podcast at the University of Maryland Medical Center.
Video: About Barrett's
Short video discussing various aspects of Barrett's esophagus from mayoclinic.com.
ASGE guideline: The Role of Endoscopy in the Surveillance of Premalignant Conditions of the Upper GI Tract.
Screening esophagogastroduodenoscopy (EGD) for Barrett's esophagus should be considered in selected patients with chronic, longstanding gastroesophageal reflux disease (GERD). After a negative screening examination, further screening endoscopy is not indicated. The cost effectiveness of surveillance in patients without dysplasia is controversial...See National Guideline Clearinghouse major recommendations.
Quality Indicators for Esophagogastroduodenoscopy.
Except in cases of esophageal or gastric outlet obstruction, every EGD should include a complete visualization of all the organs of interest from the upper esophageal sphincter to the second portion of the duodenum. This may entail efforts to clear material from the fundus, as in assessment for the source of upper GI hemorrhage. Written documentation should confirm the extent of the examination. If an abnormality is encountered, photo documentation is necessary. In studies of the learning curve of EGD, more than 90% of trainees successfully perform technically complete EGD after 100 cases...
See National Guideline Clearinghouse major recommendations.
American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease.
In the development of this medical position statement, 12 broad questions pertinent to diagnostic and management strategies for patients with gastroesophageal reflux disease (GERD) were developed by interaction among the authors of the technical review (see "Availability of Companion Documents" field), representatives from the American Gastroenterological Association (AGA) Institute Council, and the AGA Institute Clinical Practice and Quality Management Committee. The questions were designed to encapsulate the major management issues encountered in patients with GERD in current clinical practice. See National Guideline Clearinghouse major recommendations.
The role of porfimer sodium (Photofrin™) in the ablation of high-grade dysplasia associated with Barrett’s esophagus.
The early treatment of Barrett's esophagus with photodynamic therapy (PDT) in an attempt to prevent the possible later development of adenocarcinoma is clinically compelling. Presently, the best evidence in favour of PDT with porfimer sodium for these patients is the randomized controlled trial (RCT), which showed superiority for PDT treatment over treatment with omeprazole alone for both complete ablation of high-grade dysplasia (HGD) associated with Barrett's esophagus and the later development of adenocarcinoma. However, a randomized controlled trial comparison between surgery alone and PDT with porfimer sodium for these patients has yet to be published. See National Guideline Clearance Guidelines.
Abstract: Screening for Barrett's esophagus in asymptomatic women.
Barrett's esophagus (BE) has been detected in approximately 10% of patients with chronic GERD. Previous studies demonstrated a similar prevalence of BE in asymptomatic adults. OBJECTIVE: To determine the prevalence of BE in asymptomatic women. See Abstract at PubMed.
Abstract: The extent and determinants of prescribing and adherence with acid-reducing medications: a national claims database study.
No community-based, large-scale studies have examined the extent of prescribing acid-reducing medications or adherence and persistence to these medication regimens. METHODS: We conducted a retrospective cohort study of patients with Barrett's esophagus (BE) and gastroesophageal reflux disease (GERD) without BE, diagnosed between 2000 and 2005, who had undergone an upper endoscopy within 1 year through a managed care plan in the United States. We identified filled prescriptions for oral proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) within 365 days after the index date of BE or GERD, and several measures of adherence (medication-ownership ratio (MOR)) and persistence (length of therapy, fill-refill ratio, discontinuation rate) for PPI treatment. See Abstract at PubMed.
Abstract: An open-label, prospective trial of cryospray ablation for Barrett's esophagus high-grade dysplasia and early esophageal cancer in high-risk patients.
Endoscopic ablation of Barrett's esophagus (BE) is a treatment option for patients with high-grade dysplasia (HGD) and intramucosal carcinoma (IMCA). OBJECTIVE: To assess the safety and efficacy of a unique noncontact method of liquid nitrogen cryoablation as measured by histologic response rate and cancer-free survival. See Abstract at PubMed
Abstract: Comparison of reflux esophagitis and its complications between African Americans and non-Hispanic whites.
AIM: To determine the effect of ethnicity on the severity of reflux esophagitis (RE) and its complications. METHODS: A retrospective search of the endoscopy database at the University of Florida Health Science Center/Jacksonville for all cases of reflux esophagitis and its complications from January 1 to March 31, 2001 was performed. Inclusion criteria were endoscopic evidence of esophagitis using the LA classification, reflux related complications and self-reported ethnicity. The data obtained included esophagitis grade, presence of a hiatal hernia, esophageal ulcer, stricture and Barrett's esophagus, and endoscopy indication. Full text available free through PubMed.
Abstract: Medication Usage and the Risk of Neoplasia in Patients With Barrett's Esophagus.
Experimental evidence indicates that proton pump inhibitors (PPIs), nonsteroidal anti-inflammatory drugs (NSAIDs)/aspirin, and statins can protect patients with Barrett's esophagus (BE) from developing neoplasias. However, only limited data are available on chemoprevention in patients with BE. See Abstract at PubMed.
Abstract: Centralization of esophageal cancer surgery: does it improve clinical outcome?
The volume-outcome relationship for complex surgical procedures has been extensively studied. Most studies are based on administrative data and use in-hospital mortality as the sole outcome measure. It is still unknown if concentration of these procedures leads to improvement of clinical outcome. The aim of our study was to audit the process and effect of centralizing oesophageal resections for cancer by using detailed clinical data. Full text available free through PubMed.
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Illustration of digestive tract
Source: Wikimedia
Endoscopic view of Barrett's esophagus
Source: Wikimedia
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Normal esophageal cells (right side); Abnormal esophageal cells (left side blue) consistent with Barrett's esophagus.
Source: Wikimedia
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