Barrett’s Esophagus
Roy C. Orlando in Gastroesophageal Reflux Disease, 2000
Barrett’s esophagus is the condition in which an abnormal columnar epithelium replaces the stratified squamous epithelium that normally lines the distal esophagus (1). The condition is a sequela of chronic gastroesophageal reflux disease (GERD) in most, if not all, cases. On histological examination, the columnar lining of Barrett’s esophagus usually is an incomplete form of intestinal metaplasia that may have features of small intestinal, colonic, and gastric epithelia (Fig. 1) (2). This metaplastic lining has been called specialized columnar epithelium or specialized intestinal metaplasia, and it appears to be more resistant to reflux-induced injury than the native squamous mucosa (3). Unfortunately, the metaplastic cells of Barrett’s esophagus are predisposed to develop genetic changes that lead to malignancy. Indeed, GERD and Barrett’s esophagus are the major recognized risk factors for esophageal adenocarcinoma (1,4).
Endoscopic Biopsy Demonstrating High-Grade Dysplasia in Barrett’s Esophagus
Savio George Barreto, Shailesh V. Shrikhande in Dilemmas in Abdominal Surgery, 2020
The patient’s situation was discussed at the local multidisciplinary team meeting, and ablation of the mucosa demonstrating dysplasia using radiofrequency ablation was recommended. Barrett’s esophagus is present when the normal distal esophageal squamous mucosa is replaced by a metaplastic columnar mucosa containing goblet cells. Most individuals diagnosed with high-grade dysplasia should be offered treatment which aims to remove or destroy the Barrett’s esophagus mucosal segment, and thereby prevent progression to cancer. Traditionally, the treatment for Barrett’s esophagus entailed an esophagectomy for individuals with high-grade dysplasia or early stage cancer. However, comorbidities and advancing age have limited esophagectomy to a subset of younger and fitter individuals. As endoscopic therapies preserve the intact esophagus, they are believed to offer a better quality of life compared to an esophagectomy. Barrett’s esophagus progresses to adenocarcinoma via dysplasia, with high grade dysplasia being the last step before invasive cancer.
Esophagus: A Tissue Engineering Challenge
John P. Fisher in Tissue Engineering, 2007
The esophagus, a muscular/mucosal tube connecting the mouth and pharynx to the stomach, is critical for life (and good quality of life) (Figure 25.1). This seemingly simple organ is surgically challenging to repair or replace. There are a number of conditions where surgical repair of the esophagus is indicated. These include accident and trauma, congenital defects such as esophageal atresia (incomplete formation of the esophagus) and tracheoesophageal fistulas and cancer. In 2003, roughly 14,000 people in the United States were diagnosed with esophageal cancer. The prevalence of esophageal cancer in the general population can be 10 to 100 times higher in Iran, China, Singapore, India, and South Africa. Worldwide, cancer of the esophagus is the seventh leading cause of cancer death.
Increased DNA adducts in Barrett's esophagus and reflux-related esophageal malignancies
Published in Annals of Medicine, 2002
Jukka T Salminen, O Juhani Rämö, Markku O Ahotupa, Martti A Färkkilä, Jarmo A Salo
BACKGROUND. DNA adduct formation can initiate carcinogenic processes. AIM. To examine the pre-malignant condition of Barrett's esophagus by measuring the DNA adducts. METHODS. DNA adducts were measured in the proximal and distal esophagus of patients with Barrett's esophagus (n = 9), patients with adenocarcinoma in the distal esophagus/esophagogastric junction (n = 28), and in control group of patients (n = 8) using the 32-P-postlabeling method. The average levels of DNA adducts are expressed as mean adducts/10 9 nucleotides - standard error of the mean. RESULTS. The average DNA adduct levels in the distal esophagus were significantly higher in both the Barrett's esophagus (24.5 - 7.9) and the adenocarcinoma (12.0 - 3.0) than in the control patients (0.1 - 0.08), P < 0.001. In the proximal esophagus, the DNA adduct levels were approximately equal in the Barrett's esophagus (7.0 - 1.0) and in the adenocarcinoma group (6.4 - 0.65). However, the levels in the proximal esophagus in both groups were significantly higher than in the control group (2.1 - 0.67), P < 0.05. CONCLUSIONS. Patients with Barrett's esophagus and patients with esophageal/esophagogastric junction adenocarcinoma had significantly more DNA adducts than the control group. These results support the current concept of the carcinogenic potential of chronic gastroesophageal reflux, and the pre-malignant condition of Barrett's esophagus.
Prevalence of and risk factors for Barrett's esophagus with intestinal predominant mucin phenotype
Published in Scandinavian Journal of Gastroenterology, 2006
Yuji Amano, Yoshinori Kushiyama, Takafumi Yuki, Yoshiko Takahashi, Ichiro Moriyama, Hiroyuki Fukuhara, Norihisa Ishimura, Kenji Furuta, Shunji Ishihara, Kyoichi Adachi, Riruke Maruyama, Yoshikazu Kinoshita
Objective. Barrett's esophagus with the intestinal predominant mucin phenotype is considered to have a higher malignant potential than that with the gastric predominant mucin phenotype. The purpose of this prospective study was to investigate the prevalence of and risk factors for Barrett's esophagus with the intestinal predominant mucin phenotype in patients undergoing endoscopy. Material and methods. A total of 1699 consecutive patients undergoing esophagogastroduodenoscopy were enrolled in the study. A targeted biopsy was performed when endoscopically observed columnar-appearing esophagus was stained with crystal violet. The sample, histologically evidenced as Barrett's esophagus, was immunohistochemically evaluated and categorized as of either gastric or intestinal predominant mucin phenotype. All the patients were requested to complete the structured questionnaire indicating their symptoms and food consumption patterns. Prevalence of and risk factors for Barrett's esophagus with and without the intestinal predominant mucin phenotype were investigated. Results. Out of 1668 patients, 629 (37.7%) were found to have endoscopic Barrett's esophagus. In 333 out of 1668 patients (19.9%), histological studies were diagnostic of Barrett's esophagus. One hundred and six of these 333 patients (31.8%) had the intestinal predominant mucin phenotype. Age, male gender and the presence of hiatal hernia were confirmed by multivariate analysis as the independent predictors for the presence of Barrett's esophagus with the intestinal predominant mucin phenotype. Conclusions. Barrett's esophagus with the intestinal predominant mucin phenotype was immunohistochemically found in 6.4% of all study patients. Older age, male gender and the presence of hiatal hernia were the risk factors for the presence of Barrett's esophagus with the intestinal predominant mucin phenotype.
Electromyography of the Esophagus and its Clinical Applications
Published in Acta Oto-Laryngologica, 1970
T. Tokita, K. Tashiro, K. Kato
The authors have succeeded in simultaneously recording electromyograms of the upper, mid-, and lower esophagus by a new intraluminal lead method designed for the examination of esophageal motility in human subjects. The following action potentials were observed in normal cases: (1) a spike-burst appeared occasionally in the mid- or lower esophagus at rest; (2) action potentials followed deglutition i.e. a spike-burst propagating from the upper to lower esophagus and repetitive spike-bursts from the lower esophagus; (3) a spike-burst elicited by instillation of drug solution; (4) a spike-burst elicited by esophageal wall distension by air insufflation. The electromyographic findings of patients with esophageal disease were clarified in each case. In a case of idiopathic esophageal dilatation a characteristic spike-burst was found in the lower esophagus which seemed to indicate the presence of cardiospasm, and many sporadic spike discharges were also observed in the mid- and lower esophagus after mecholyl injection.