2. What is Barrett’s Esophagus?
The esophagus gets a tissue
lining similar to that of the
intestines
The muscle becomes rougher
The cells that are normally
found in the intestine replace
the normal esophagus cells
3. Estimated prevalence of Barrett’s esophagus
6-12% of patients who undergo EGD for GERD.
Short-segment BE: 6-12%
Long-segment BE: 1-5%
1-2% of unselected patients who undergo EGD
Most cases go undetected in the general
population [Autopsy data]. Perhaps 5% of patients
with Barret esophagus are currently being
diagnosed.
4. Symptoms of Barretts esophagus
There are no specific
symptoms, they vary per
person
Some signs it is likely include:
Constant acid reflux
Burning sensations near chest
bone
Pain in throat and chest when
eating
5. frequent and longstanding heartburn
trouble swallowing (dysphagia)
vomiting blood (hematemesis)
pain under the breastbone where the esophagus meets
the stomach
unintentional weight loss because eating is painful
6. Risk factors for development
of Barrett’s esophagus
Male gender 3 times > female gender
White race >> Blacks & Asians
Abdominal adiposity (obesity)
Genetic factors suspected in some patients/families
Chronic reflux symptoms for > 5-10 years
Age >40-50 years; mean age at diagnosis = 55 yrs
7. Mechanism
Barrett esophagus occurs due to chronic
inflammation. The principal cause of the chronic
inflammation is gastroesophageal reflux disease,
GERD . In this disease, acidic stomach, bile, small
intestine and pancreatic contents cause damage to the
cells of the lower esophagus
8. Damage to the squamous
esophageal mucosa
Injury heals
through a metaplastic process
(columnar cells replace squamous cells)
Pathogenesis of Barrett’s Esophagus
GERD
Injury heals
with restoration of
squamous mucosa
9. Long-segment versus
short-segment Barrett’s esophagus
Long-segment BE (LSBE): >3-cm segment of distal esophagus (columnar
mucosa with intestinal metaplasia)
Short-segment BE (SSBE): <3-cm segment (usually tongues or islands of
columnar mucosa with intestinal metaplasia)
Patients with LSBE tend to have greater esophageal acid exposure than
SSBE, as well as lower LES pressures and more esophageal dysmotility.
LSBE (classic BE) is much better studied.
We are currently managing LSBE and SSBE similarly.
However, questions remain:
Does SSBE have the same pathogenesis?
Does SSBE have a lower risk of cancer?
Does SSBE progress to LSBE?
Does the length of BE correlate with cancer risk?
11. Physiology of Barrett’s
Esophagus
When food becomes backed
up, the juices of the stomach
go back up the esophagus.
This is also known as severe
acid reflux.
When having a repeated
injury to the Esophagus
, acidic fluid changes the
types of cells lining it from
squamous to columnar
.(METAPLASIA)
Fluid may contain bile acids.
12. Development of Neoplasia in Barrett’s
Esophagus
1
2Gastric acid reflux
2
1Duodenal bile reflux
Pro-carcinogenic
primary and
secondary bile salts
3
pH dependent,bile
salt induced chronic
esophageal injury
4
Chronic esophageal
inflammation and
PGE2release
5
Neoplasia in Barrett’s
esophagus
13. Development of esophageal adenocarcinoma from
Barrett’s esophagus
Compelling evidence exists for a dysplasia-carcinoma
sequence in BE.
Specialized columnar epithelium progresses in some patients
→ low-grade dysplasia → high-grade dysplasia →
adenocarcinoma.
Not every patient with low-grade dysplasia progresses, and
low-grade dysplasia can even spontaneously revert back to
no dysplasia.
Time course for development of cancer highly variable.
Most patients never progress to dysplasia. Less than 5% of
Barrett’s patients will develop cancer.
14. Why do we care about Barrett’s esophagus?
Patients with BE have an increased risk of developing esophageal
adenocarcinoma.
Over the past 30 years, the incidence of squamous cell cancer of the
esophagus has stayed constant, while the incidence of adenocarcinoma
has increased 6-fold! This is an increase that exceeds that of any other
cancer.
Today, adenocarcinoma accounts for more than half of esophageal
cancers.
Patients with BE have about a 30-40 fold increased risk of
adenocarcinoma of esophagus.
Risk of a BE patient developing cancer is estimated to be about 1 per
200 patient-years follow-up.
Despite all this, most patients with BE do not develop esophageal
cancer. [Less than 5%]
15. Diagnosis
GERD is a precursor to the
diagnosis of Barrett’s
Esophagus.
The tissue lining of the
esophagus has changed.
Endoscopy (a long thin tube
that examines the lining of
the esophagus and stomach)
confirms whether or not cells
are abnormal.
16. 1. Locate gastro-
esophageal
junction
3. Describe extent of
metaplasia
consistently
2. Recognize the
squamocolumnar
junction
Three Essential Steps for
Endoscopic Diagnosis and
Description
17. Therapy of Barrett’s Esophagus
Antisecretory therapy
Surgery
Ablation
Chemoprevention
18. TREATMENT AND
MANAGEMENT TACTICS
TREATMENT OF the mai cause that is GERD-
Treatment should improve acid reflux symptoms, and
may keep Barrett's esophagus from getting worse.
Treatment may involve lifestyle changes and
medications such as:
Antacids after meals and at bedtime
Histamine H2 receptor blockers(viz rantidine
famotidine etc)
Proton pump inhibitors(pantoprazole,lansoprazole
etc)
19. N.B.- Lifestyle changes, medications, and anti-
reflux
surgery may help with symptoms of GERD, but will
not
make Barrett's esophagus go away.
20. TREATMENT OF BARRETT'S ESOPHAGUS
Surgery or other procedures may be recommended if a
biopsy shows cell changes that are very likely to lead to
cancer. Such changes are called severe or high-grade
dysplasia.
21. Surgery
Removal of intestinal
cells from esophagus and
replacement of
esophageal cells
Removal of the
esophagus
22. Recent advance in surgical
method
Photodynamic therapy (PDT) uses a special laser
device, called an esophageal balloon, along with a drug
called Photofrin.
Other procedures use different types of high energy to
destroy the precancerous tissue.
Surgery removes the abnormal lining.
23. Fun and Interesting Facts
Only about 1% of all Americans suffer from Barret’s
Esophagus
10% to 15% of people with chronic GERD get Barrett’s
Esophagus.
About 3.3 million adults over 50 years of age in the United
States have Barrett’s Esophagus.
Men are more likely to develop Barrett’s Esophagus than
women and the ratio is 2:1, and EUROPEAN males are
more likely to have it than any other race.
