Barrett's Esophagus

Barrett's Esophagus is a disease which occurs in the lining of the Oeseophagus where intestinal metaplasia occurs due to a phenomenon called reflux esophagitis. The normal esophageal mucosa consists of squamous cell epithelium, which is not resistant to the acidic juices of the stomach. Inflammation occurs here, and with long-term irritation, often due to insufficient function of the lower esophageal sphincter, it transforms into a cylindrical epithelium with goblet cells (similar to the intestinal). This epithelium is more resistant to aggressive environments, but this intestinal metaplasia is a precancerous lesion and therefore increases the risk of esophageal adenocarcinoma. In people with Barret's Esophagus, the risk of malignancy in adenocarcinoma increases by 30-40 times and it is usually in the lower part of the esophagus at the transition of the stomach.

Risk factors
Factors are common to the occurrence of gastroesophageal reflux and a reduction in the pressure to the lower esophageal sphicter.

Risk factors include:


 * Long-term and repeated reflux of acidic gastric contents.
 * Smoking
 * Excessive alcohol consumption.
 * Motility disorder
 * Dysfunction of the lower esophageal sphincter.
 * Hiatal Hernia.

Diagnosis
The diagnosis of Barrett's Esophagus is based on endoscopy with histological examination of the biopsied material. The endoscopic finding itself is typical of Barrett's esophagus- it is visible as a marked red section of the mucosa- but it is always supplemented by histological examination. Barrett's esophagus may not show any symptoms other than those associated with reflux disease, such as heartburn. Patients with this disease should be monitored regularly.

Therapy
Full anti-reflux therapy, which leads to the suppression of the gastric juice production, using proton pump inhibitors ( Omeprazole, lansoprazole, pantoprazole, esomeprazole). This therapy is indicated even in the absence of reflux symptoms - chest pain, heartburn, odynophagia, dysphagia and others. An indication for endoscopic intervention in the Esophagus is the finding of severe dysplastic changes and removal of already proven adenocarcinoma.

Complications
Complications for Barrett's esophagus include neoplasia, strictures, and ulcers (Barrett's ulcers). Bleeding from lesions and inflammatory stenosis may occur.

'''All patients diagnosed with Barrett's Esophagus should be treated endoscopically at intervals according to previous histological findings and associated risk factors. The goal is early detection of possible dysplasias.'''

Related articles

 * Esophageal reflux disease
 * Metaplasia
 * Precancerous lesions
 * Swallowing

Reference
KROUPA, Radek. Barrett's esophagus, risk factors, treatment [online]. [feeling. 2017-10-03]. <

https://www.internimedicina.cz/pdfs/int/2012/03/04.pdf