Updated: 7/5/2020

Barrett Esophagus

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Topic
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Questions
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100%
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Evidence
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Topic
Snapshot
  • A 52-year-old man presents to the emergency room with chest pain. He denies any pain with physical exertion. He just had a large, fatty, spicy meal. His cardiac work-up is negative. He has had GERD for the past ten years now but recently developed increasing heartburn and regurgitation. His BMI is 31 kg/m2. His emergency room physician recommends that he continue using proton pump inhibitors and schedules an outpatient primary care appointment for him. In a note to his PCP, he suggests a screening endoscopy. 
Introduction
  • Metaplastic transformation of esophageal lining 
    • normal squamous epithelium
    • → columnar epithelium 
    • intestinal metaplasia (with globlet cells)
  • Result of chronic gastroesophageal reflux disease (GERD)
  • Pathogenesis
    • mucosal injury causes acute and chronic inflammatory change
    • esophageal stem cells develop columnar metaplasia
  • Risk factors
    • GERD > 5-10 years
      • 10% incidence of Barrett esophagus in GERD patients
    • age > 50 years
    • male > female
    • obesity
  • Associated conditions
    • risk of progression to adenocarcinoma
Presentation
  • Symptoms
    • heartburn
    • regurgitation
  • Physical exam
    • typically normal
Evaluation
  • Diagnosis with upper endoscopy with biopsy showing both
    • histology 
      • metaplastic columnar epithelium with goblet cells (normally in stomach and intestines) in esophageal mucosa
    • visualization of abnormal distal esophageal mucosa
Differential Diagnosis
  • Erosive esophagitis
  • Gastritis
Treatment
  • Lifestyle modifications
    • weight loss
    • elevate head of bed
  • Proton pump inhibitor for GERD
  • Endoscopic surveillance 
    • absence of dysplasia
      • repeat endoscopy in 3-5 years 
    • low-grade dysplasia
      • repeat endoscopy in 6-12 months
        • most experts prefer eradication therapy with radiofrequency ablation
  • Surgical intervention for prevention of cancer with unclear benefits
Prognosis, Prevention, and Complications
  • Prognosis
    • ↑ lifetime risk of esophageal cancer
      • 5% in men
      • 3% in women
    • ↑ annual risk of esophageal cancer in Barrett's esophagus
      • 0.5% - 2.8% per year
  • Complications
    • progression to adenocarcinoma
    • ulceration leading to stricture formation

Please rate topic.

Average 4.1 of 9 Ratings

Questions (2)

(M2.GI.16.4694) A 46-year-old overweight male presents to his primary care physician for an annual checkup. He has a history of gastroesophageal reflux disease (GERD) with biopsy confirming Barrett's esophagus on therapy with omeprazole. Review of systems is unremarkable, and the patient is otherwise doing well. Vitals are within normal limits and stable. The patient asks about the need for continuing his omeprazole therapy. You recommend he continue his medication because of which of the following most probable long-term sequelae associated with Barrett's esophagus?

QID: 107751
1

Adenocarcinoma

80%

(4/5)

2

Squamous cell carcinoma (SCC)

0%

(0/5)

3

Transitional cell carcinoma

20%

(1/5)

4

Gastro-intestinal stromal tumor (GIST)

0%

(0/5)

5

MALT lymphoma

0%

(0/5)

M 8 E

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Evidence (2)
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