Patients suffering from BE are usually of advanced age and have a medical history of chronic GERD. The latter is typically associated with acid regurgitation, heartburn, retrosternal chest pain, and dysphagia. It has been suggested that individuals previously diagnosed with GERD-related erosive esophagitis are more likely to develop BE [5], but these data are primarily of epidemiological relevance since a considerable subset of BE patients remains entirely asymptomatic. Accordingly, it has been recommended to perform annual or biannual esophagoscopy examinations in men who have presented GERD-associated symptoms for more than five years if either two of the following risk factors are present: age >50 years, Caucasian, family history of BE, obesity, smoker [2]. These features define the "classical" BE patient. Eventually, BE may constitute an incidental finding encountered during endoscopic procedures realized for non-related reasons.

Progression to esophageal adenocarcinoma occurs in about 0.5% of BE patients per year [4]. Disease progression may entail additional symptoms like exacerbated dysphagia, persistent cough, weight loss, as well as symptoms associated with metastatic adenocarcinoma [6] [7].

• Hoarseness

  Other common symptoms include incessant coughing, hoarseness, or an sore or itchy throat. However some may not experience any symptoms. Unfortunately, people will ignore symptoms and take antacids or continue to use other methods to ease heartburn. [sagastro.com]

  They include heartburn, regurgitation, throat clearing, hoarseness, nausea or indigestion. But some people with Barrett’s esophagus don’t have reflux symptoms. Or they may have them for some time, but the symptoms go away. [newsnetwork.mayoclinic.org]

  Some people with GERD have only a sore throat, chronic cough, or hoarseness. Others have no symptoms at all. Plus and Minus Icon Several lifestyle and dietary habits can make gastroesophageal reflux disease continue or worsen. [mskcc.org]

  Many people who have GERD, Barrett’s esophagus, or both experience symptoms such as heartburn, or a burning sensation in the chest; sore throat; cough; hoarseness; difficulty swallowing; or chest pain. [nyulangone.org]

• Dysphagia

  A 19-year-old neurologically impaired man underwent endoscopy for evaluation of dysphagia and vomiting, and was diagnosed with EAC with BE. [ncbi.nlm.nih.gov]

  Any dysphagia (difficulty swallowing) in association with reflux symptoms is concerning and further assessment should be done to look for a stricture or tumor in the esophagus. [memorialhermann.org]

  In patients who are developing a mass or nodule arising from within the Barrett’s esophagus region, suggestive of the transformation of the area into a cancer, difficulties in swallowing, or dysphagia, may develop as well. [uclahealth.org]

• Abdominal Pain

  Patients who do have symptoms may experience: Frequent heartburn Waking in the night due to heartburn or cough Difficulty swallowing food Vomiting Blood in vomit or stool Chest pain Upper abdominal pain Chronic, dry cough Laryngitis or voice changes Nausea [brighamandwomens.org]

  These symptoms include: dry cough, frequent heartburn, chest pain, difficulty swallowing food and abdominal pain. These should be evaluated by a gastroenterologist. [manhattangastroenterology.com]

  Symptoms Common Barrett's Esophagus symptoms Heartburn (burning sensation behind the breast bone) Epigastric pain (upper abdominal pain) Dysphagia (difficulty swallowing or the sensation that food is hanging up or not passing down into the stomach properly [memorialhermann.org]

  Your husband's symptoms of vomiting, right sided abdominal pain and a choking sensation after going to bed are suggestive, but not necessarily diagnostic, for gastroesophageal reflux. [henryford.com]

• Odynophagia

  The major complications were chest pain and odynophagia, which occurred in 57.5% of patients and lasted 3-10 days. Only 3 patients experienced stricture, which was treated easily with dilation. [emedicine.medscape.com]

  […] however, is associated with these symptoms: frequent and longstanding heartburn trouble swallowing (dysphagia) vomiting blood (hematemesis) pain under the sternum where the esophagus meets the stomach unintentional weight loss because eating is painful (odynophagia [en.wikipedia.org]

  Obviously, patients with alarm symptoms such as dysphagia, odynophagia, bleeding, or weight loss should be referred promptly for endoscopy. In patients without alarm symptoms, screening guidelines for Barrett’s esophagus are somewhat problematic. [aafp.org]

  These include lower rates of chest pain, odynophagia, perforation and pneumothorax in comparison with laser and thermal ablation techniques. [bjmp.org]

• Epigastric Pain

  Symptoms Common Barrett's Esophagus symptoms Heartburn (burning sensation behind the breast bone) Epigastric pain (upper abdominal pain) Dysphagia (difficulty swallowing or the sensation that food is hanging up or not passing down into the stomach properly [memorialhermann.org]

  The frequent chief complaints were epigastric pain (27.3%) and chronic acid reflux symptom (18.2%). Three patients (27.3%) were detected incidentally during screening endoscopy. [kci.go.kr]

• Pyrosis

  Populations evaluated Uncomplicated GER Patients had uncomplicated GER if they had: - typical symptoms (heartburn, regurgitation, pyrosis) as a primary complaint; - typical symptoms that were not a primary complaint but elicited during the history; - [hon.ch]

Diagnosis of BE is based on endoscopic findings and histopathological analyses of biopsy specimens. With regards to the former, metaplastic columnar epithelium is of intense red color and confers a velvety aspect to the esophageal mucosa. In contrast, healthy stratified squamous epithelium appears pale and glossy [8].

BE is frequently referred to as "intestinal metaplasia" because affected mucous membranes resemble small intestinal epithelium. It has to be noted, though, that columnar epithelium as observed in BE patients differs considerably from intestinal mucous membranes, e.g., with regards to gene expression profiles and the cells' ability to differentiate [9]. The pathohistological picture is dominated by pathognomonic mucin-containing acid, Alcian blue-staining goblet cells and periodic acid-Schiff positive cells that harbor neutral mucin [10]. Endocrine and Paneth cells have been identified in samples obtained from BE patients.

If erosive esophagitis is diagnosed at the time of endoscopic examination and biopsy, these diagnostic measures have to be repeated at a later point in time.

• Gram-Positive Bacteria

  The esophageal microbiome is altered in both esophagitis and Barrett esophagus, characterized by a significant decrease in gram-positive bacteria and an increase in gram-negative bacteria in esophagitis and Barrett esophagus. [ncbi.nlm.nih.gov]

• Multiple Ulcerations

  Multiple ulcerations in the region of the stricture are seen. Note the reticular mucosal appearance extending down from the inferior aspect of the stricture. [emedicine.com]

Barrett esophagus (BE) may complicate gastroesophageal reflux disease (GERD). In detail, chronic exposure of the esophageal mucosa to gastric acid results in the replacement of stratified squamous epithelium with metaplastic columnar epithelium [1]. In accordance with the disease' etiology, mucosal alterations consistent with BE affect distal portions of the esophagus. However, tissue samples should not be obtained within less than 1 cm of the esophagogastric junction in order to guarantee reliable results [2]. BE is considered a precancerous condition and affected individuals are predisposed for esophageal adenocarcinoma [3].

BE patients are generally prescribed proton pump inhibitors and antacids, and these drugs may alleviate symptoms associated with GERD. Unfortunately, they are unable to reverse structural remodeling processes affecting the esophageal mucosa. Treatment options available to date comprise thermal, photochemical, or mechanical, endoscopic ablation and esophagectomy [4].

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