Recently at morning report we had a great discussion about Barrett’s esophagus in regards to diagnosis and management. Check out this prior blog post with a link to the NEJM review article by Dr. Spechler. Check out the key points below!
- Barrett’s esophagus is the condition in which a metaplastic columnar mucosa replaces esophageal squamous mucosa damaged by gastroesophageal reflux disease (GERD)
- This columnar mucosa increases the risk of esophageal cancer (adenocarcinoma)
- Estimated that 5.6% of adults have Barrett’s esophagus in the United States
- Diagnosis requires findings on endoscopy that columnar mucosa extends above the gastroesophageal junction, lining the distal esophagus
- PLUS biopsy that confirms the presence of columnar metaplasia
- Risk Factors: white, male, obesity, older age, chronic heartburn, hiatal hernia, etc.
- Medical societies currently recommend endoscopic screening for Barrett’s esophagus in patients with chronic GERD symptoms who have at least one additional risk factor for esophageal adenocarcinoma
- Patients found to have nondysplastic Barrett’s metaplasia, medical societies recommend regular endoscopic surveillance at intervals of 3 to 5 years
- The efficacy and benefits of screening and surveillance have come under greater scrutiny in recent years
- Refluxed gastric acid can cause chronic inflammation, double-strand DNA breaks, and increased cell proliferation, all of which may contribute to carcinogenesis à GERD should be aggressively treated
- Indirect evidence that PPI’s decrease the risk of cancer development in patients with Barrett’s
- Dysplasia remains the basis for clinical decision making in cases of Barrett’s esophagus
- The standard treatment for high-grade dysplasia was esophagectomy but with recent developments, endoscopic resection and ablation techniques are now available to eradicate dysplasia
- For patients with confirmed low-grade dysplasia, gastroenterology societies currently recommend either endoscopic surveillance at intervals of 6 to 12 months or endoscopic ablation therapy
Image courtesy of Spechler, Souza. “Barrett’s Esophagus.” NEJM. 2014.