- metaplasia of normal squamous epithelium to abnormal columnar epithelium containing foci of intestinal metaplasia and resulting displacement of the squamocolumnar junction proximal to the gastroesophageal junction.
- thought to be acquired via long-standing GERD and consequent damage to squamous epithelium.
- a significant proportion of patients with Barrett's Esophagus (BE) do not report symptoms of GERD (up to 25%).
- up to 10% of GERD patients will have already developed BE by the time they seek medical attention.
- more common in males, >50 yrs, Caucasians and smokers.
- vigorous surveillance and endoscopic intervention is thought to reduce the risk of death from adenocarcinoma.
- most patients with BE are elderly and die of causes other than esophageal cancer.
the rate of malignant transformation is 0.5-1.0% per year.
risk of malignant transformation in high-grade dysplasia is significantly higher , it's 32-59% per 5-8 years of surveillance
Diagnosis:
- diagnosis relies on biopsy
- endoscopy : erythematous epithelium in distal esophagus;
- biopsy : the presence of specialized intestinal epithelium of any length within the esophagus , premalignant changes in abnormal columnar epithelium, characterized as low- or high-grade dysplasia.
Treatment:
- acid suppressive therapy with high-dose proton pump inhibitor for symptoms relief.
- anti-reflux surgery (fundoplication) , endoscopic ablation of dysplastic areas , endoscopic mucosal resection.
- endoscopic surveillance every 2-3 years once diagnosis of BE established; frequency increased to annually once presence of low-grade dysplasia detected on biopsy.
- surgical intervention recommended for most patients with high-grade dysplasia.
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