barrett's%20esophagus
BARRETT'S ESOPHAGUS
Barrett's esophagus is defined as the endoscopic finding in the distal esophagus of proximal-appearing columnar-lined esophagus of at least 1-cm length that is confirmed by histology.
It is considered a premalignant metaplastic condition that usually involves the distal esophagus.
It is postulated that exposure of the esophageal epithelium to acid damages the lining resulting in chronic esophagitis and its healing involves metaplastic process.

Diagnosis

  • The main reason to evaluate patients with chronic gastroesophageal reflux disease (GERD) symptoms is to identify Barrett’s esophagus
    • Patients with chronic GERD are the most at risk to develop Barrett’s esophagus and should undergo upper endoscopy
    • Endoscopy to screen for Barrett’s esophagus is recommended in patients with >5 years of GERD symptoms
    • Routine screening of GERD patients may not be appropriate in the Asian population because of the low prevalence of Barrett’s metaplasia in Asia
  • Patients with alarm symptoms or high risk should be immediately referred for endoscopy to screen for malignancy or Barrett’s esophagus
    • Alarm symptoms: Dysphagia, odynophagia, bleeding, weight loss
  • Those who have had GERD symptoms of >3x/week for >20 years have 40-fold increased risk of developing adenocarcinoma
  • Many patients who develop Barrett’s esophagus are asymptomatic
    • 40% of patients with esophageal adenocarcinoma have no history of GERD
  • Decision to screen should be individualized

Physical Examination

  • Clinicians must examine the patient and look for any sign of extraesophageal disease, complications of advanced disease or any underlying disease that may manifest as GERD

Surgical Test

Endoscopy

  • Each upper endoscopy should record the squamocolumnar junction, the gastroesophageal junction and if a hiatal hernia is present, the location of the diaphragmatic hiatus, in patients suspected of Barrett’s esophagus
    • The Asia-Pacific consensus defines the gastroesophageal junction as the proximal limits of gastric folds
  • Use Prague criteria in documenting extent of suspected Barrett’s esophagus on endoscopy
  • Consider for endoscopic screening patients, with or without history of reflux symptoms, with a family history of >2 first-degree relatives with Barrett’s esophagus or esophageal adenocarcinoma
  • If initial endoscopy is negative, it is not recommended to repeat it; however, in patients with suspected Barrett’s and negative histology, endoscopy may be repeated in 1-2 years
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