Barrett esophagus is a precancerous condition and complication of gastroesophageal reflux disease that predisposes for esophageal adenocarcinoma. Chronic exposure of the esophageal mucosa results in an adaptive response and replacement of stratified squamous epithelium with metaplastic columnar epithelium.
Presentation
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].
Entire Body System
- Pain
Symptoms Barrett’s esophagus often doesn’t have any symptoms, but symptoms of GERD, heartburn and acid reflux include: Burning or pain in the chest Pain that increases after meals or lying down View all Barrett’s esophagus symptoms Delivering the Latest [digestive.templehealth.org]
Some of the typical GERD symptoms include: Chest pain* Difficulty swallowing food Frequent heartburn or acid reflux *Note: Seek immediate medical attention if you experience chest pain accompanied by shortness of breath or jaw or arm pain. [umiamihealth.org]
Since then, I have not had the heartburn and pain I was having. Recently, I've noticed a slight tightness in my chest and a little pain. [henryford.com]
The signs and symptoms that you experience are generally due to GERD and may include: Frequent heartburn Difficulty swallowing food Less commonly, chest pain Many people with Barrett's esophagus have no signs or symptoms. [mayoclinic.org]
- Swelling
Other conditions, such as inflammation or swelling of the esophageal lining, can make cells appear dysplastic when they may not be. [westchestergi.com]
You may also get it if you have swelling of the esophagus (esophagitis). These health problems harm the lining of your esophagus. This can cause the abnormal cells to take over. [urmc.rochester.edu]
Complications of photodynamic therapy may include: sensitivity of your skin and eyes to light for about 6 weeks after the procedure burns, swelling, pain, and scarring in nearby healthy tissue coughing, trouble swallowing, stomach pain, painful breathing [crh.org]
- Burning Pain
A burning pain when you swallow hot drinks. Like heartburn, these symptoms tend to come and go and tend to be worse after a meal. [patient.info]
- Fever
The following are transient side effects that may be expected after treatment with Barrx™ radiofrequency ablation system: chest pain, difficulty swallowing, painful swallowing, throat pain and/or fever. [medtronic.com]
Respiratoric
- 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]
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]
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]
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]
These include: Bronchitis Chronic cough Hoarseness New onset adult asthma Sore throat Who to See and Types of Treatments Available Barrett’s esophagus treatment begins with assessment and diagnosis with endoscopy, in which a lighted flexible tube with [docdoc.com.sg]
Gastrointestinal
- Dysphagia
The latter is typically associated with acid regurgitation, heartburn, retrosternal chest pain, and dysphagia. [symptoma.com]
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]
- 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]
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]
In many cases, it is asymptomatic, even though postprandial abdominal pain or, during exercise, nauseas, vomiting, and weight loss could be found. [websurg.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
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]
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]
- 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]
Cardiovascular
- Chest Pain
The signs and symptoms that you experience are generally due to GERD and may include: Frequent heartburn Difficulty swallowing food Less commonly, chest pain Many people with Barrett's esophagus have no signs or symptoms. [mayoclinic.org]
Some of the typical GERD symptoms include: Chest pain* Difficulty swallowing food Frequent heartburn or acid reflux *Note: Seek immediate medical attention if you experience chest pain accompanied by shortness of breath or jaw or arm pain. [umiamihealth.org]
Some patients remain asymptomatic of heartburn or chest pain even in the presence of severe reflux disease. The lack of heartburn or chest pain does not mean you do not have reflux disease. [brighamandwomens.org]
Skin
- Flushing
Some patients may experience nausea, vomiting, cramping, flushing (blushing; redness of the skin), or diarrhea when their stomachs become overly full (distended); limiting liquids with your meals may help reduce these symptoms. [ctsurgerypatients.org]
Controlling gastric reflux - stomach acid that flushes back up into the lower esophagus - is vital in preventing further damage to the esophageal lining. [virginiamason.org]
Workup
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.
Microbiology
- Helicobacter Pylori
The two groups did not differ statistically regarding the variables gender, GERD symptoms, Helicobacter pylori infection ( Table 1 ). [scielo.br]
Having a Helicobacter pylori (H. pylori) infection may decrease your chances of developing Barrett’s esophagus. Doctors are not sure how H. pylori protects against Barrett’s esophagus. [niddk.nih.gov]
"Chronic inflammation at the gastroesophageal junction (carditis) appears to be a specific finding related to Helicobacter pylori infection and gastroesophageal reflux disease. The Central Finland Endoscopy Study Group.". [librepathology.org]
H. pylori and Barrett's esophagus H. pylori (or Helicobacter pylori) infection may decrease the risk of developing Barrett's esophagus. [ddc.musc.edu]
Helicobacter Pylori H. pylori is a spiral-shaped bacterium found in the stomach, which (along with acid secretion) damages stomach and duodenal tissue, causing inflammation and peptic ulcers. [massgeneral.org]
Treatment
Treatments Barrett’s esophagus will not go away on its own. It must be treated through endoscopic treatments or surgery. [nm.org]
For many patients these treatment options seemed at opposite ends of the treatment spectrum, and neither seemed appropriate for a pre-cancerous condition. [wakehealth.edu]
Treatment What treatment is available for Barrett’s Oesophagus? Barrett’s Oesophagus with Dysplasia The treatment for Barrett’s Oesophagus has changed significantly over recent years. [gutscharity.org.uk]
Treatment for Barrett's oesophagus Treatment includes: Medications – once Barrett’s oesophagus has been diagnosed, it is essential that treatment is given to eliminate acid reflux. [betterhealth.vic.gov.au]
Prognosis
He underwent transthoracic esophagectomy, extensive lymph node dissection, and cervical esophagogastric anastomosis, but the prognosis was poor. Pathology indicated poorly differentiated adenocarcinoma with BE. [ncbi.nlm.nih.gov]
adenocarcinoma oesophagus prognosis, adenocarcinoma of esophagus, adenocarcinoma of esophagus prognosis, adenocarcinoma of oesophagus, adenocarcinoma of the esophagus, adenocarcinoma of the oesophagus, adenocarcinoma throat, adrenal cancer, advanced [youtube.com]
Etiology
METHODS: The English-language literature relating to tumor epidemiology, etiology, and the pathogenesis of BE was reviewed and summarized. [ncbi.nlm.nih.gov]
Epidemiology
Medizinische Klinik, Klinilkum rechts der Isar, Technische Universitaet München, Munich, Germany. 2 Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universitaet, Munich, Germany. 3 Institute [ncbi.nlm.nih.gov]
Barrett's esophagus: Epidemiology, clinical manifestations, and diagnosis. http://www.uptodate.com/home. Accessed Feb. 17, 2017. Shaheen NJ, et al. ACG clinical guideline: Diagnosis and management of Barrett's esophagus. [mayoclinic.org]
Pathophysiology
In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Feb. 17, 2017. Hu Q, et al. [mayoclinic.org]
Further long-term follow-up prospective study needs to verify the current results, and definite pathophysiological mechanism needs to be further investigated and clearly elucidated. [ncbi.nlm.nih.gov]
Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management.10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 45. Updated by: Michael M. [medlineplus.gov]
Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management.10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 45. Version Info Last reviewed on: 1/12/2018 Reviewed by: Michael M. [mountsinai.org]
Prevention
Benefits This procedure can minimize or prevent abnormal cells from developing into a cancerous condition of the esophagus. [jerseyshoreuniversitymedicalcenter.com]
People should talk with their health care provider about dietary changes that can help prevent Barrett's esophagus. [ddc.musc.edu]
Regular endoscopic surveillance for dysplasia is the currently recommended cancer prevention strategy for Barrett esophagus, but a high-quality study has found no benefit of surveillance in preventing deaths from esophageal cancer. [ncbi.nlm.nih.gov]
Long-term studies will be needed to see if any of these treatments prevent the development of cancer. [texasoncology.com]
BETRNet, a multi-disciplinary, multi-institutional collaboration co-sponsored by NCI's Division of Cancer Prevention and Division of Cancer Biology, was established to centralize and enhance efforts to understand Barrett's esophagus (BE) and to prevent [prevention.cancer.gov]
Summary
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].
References
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- Falk GW. Updated Guidelines for Diagnosing and Managing Barrett Esophagus. Gastroenterol Hepatol (N Y). 2016;12(7):449-451.
- Kalatskaya I. Overview of major molecular alterations during progression from Barrett's esophagus to esophageal adenocarcinoma. Ann N Y Acad Sci. 2016;1381(1):74-91.
- McAllaster JD, Buckles D, Al-Kasspooles M. Treatment of Barrett's esophagus with high-grade dysplasia. Expert Rev Anticancer Ther. 2009;9(3):303-316.
- Ronkainen J, Talley NJ, Storskrubb T, et al. Erosive esophagitis is a risk factor for Barrett's esophagus: a community-based endoscopic follow-up study. Am J Gastroenterol. 2011;106(11):1946-1952.
- Vats HS, Banerjee TK, Resnick J, Khan Q. Esophageal adenocarcinoma arising from Barrett's dysplasia: a case report of double occurrence and prolonged survival after chemotherapy. Clin Med Res. 2006;4(3):184-188.
- Triantafyllou S, Georgia D, Gavriella-Zoi V, et al. Cutaneous metastases from esophageal adenocarcinoma. Int Surg. 2015;100(3):558-561.
- Spechler SJ. Barrett esophagus and risk of esophageal cancer: a clinical review. Jama. 2013; 310(6):627-636.
- Goldblum JR. Barrett's esophagus and Barrett's-related dysplasia. Mod Pathol. 2003;16(4):316-324.
- Yamamoto Y, Wang X, Bertrand D, et al. Mutational spectrum of Barrett's stem cells suggests paths to initiation of a precancerous lesion. Nat Commun. 2016;7:10380.