Gastroenterology Book

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Barrett's EsophagusAka: Barrett's Metaplasia

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  1. See Also
    1. Gastroesophageal Reflux Disease
    2. Esophageal Adenocarcinoma
  2. Pathophysiology
    1. Columnar metaplasia of distal esophagus
    2. Response to chronic inflammation
      1. Gastroesophageal Reflux
  3. Risk Factors
    1. Gastroesophageal Reflux
      1. GERD Symptoms > 3x/week for 20 years: RR = 40
    2. Racial predisposition
      1. Caucasian
      2. Hispanic
    3. Older age
    4. Tobacco Abuse (2 fold increase in Esophageal Cancer)
    5. Male gender
    6. Obesity
  4. Endoscopy
    1. Indications for screening for Barrett's Esophagus
      1. Significant risk factors above
      2. Red flag symptoms
        1. Dysphagia
        2. Odynaphagia
        3. Upper Gastrointestinal Bleeding
        4. Weight loss
    2. Surveillance and management protocol (controversial)
      1. Consider screening only once in patients with GERD
      2. Barrett's Esophagus without dysplasia
        1. Repeat endoscopy with biopsy in one year
        2. If no dysplasia x2, then endoscopy every 3-5 years
      3. Low grade dysplasia
        1. Repeat endoscopy with biopsy in 6 months
        2. Then repeat upper endoscopy annually
      4. High grade dysplasia: Upper endoscopy q3 months
        1. Consider esophagectomy if able to undergo surgery
        2. Consider ablation if not able to undergo surgery
    3. Findings consistent with Barrett's Esophagus
      1. Z-line is squamocolumnar junction
        1. Z-Line is normally at gastroesophageal junction
      2. Barrett's Esophagus
        1. Z-line shifts up from gastroesophageal junction
        2. Long-segment Barrett's: >3 cm from junction
        3. Short-segment Barrett's: <3 cm from junction
    4. Screening difficulties
      1. Esophageal Cancer is uncommon, even in Barrett's
      2. Most Esophageal Cancer patients have no GERD symptoms
      3. Longterm surveillance is still recommended
      4. References
        1. Gopal (2002) Evid Based Oncol 3(4):144
        2. Hage (2004) Scand J Gastroenterol 39:1175
  5. Endoscopy factors predicting low risk of adenocarcinoma
    1. Low grade or no dysplasia on initial endoscopy and
    2. Barrett's Esophagus length <6 cm
    3. Weston (2004) Am J Gastroenterol 99:1657
  6. Complications of Barrett's Esophagus
    1. Esophageal Adenocarcinoma
      1. Cancer Incidence on first endoscopy: 0.5% per year
  7. References
    1. Kahrilas in Feldman (2002) Sleisenger GI, p. 615-8
    2. Katzka (2003) Hematol Oncol Clin North Am 17(2):471
    3. Spechler (2002) N Engl J Med 346:836

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