Barrett esophagus


[Norman R. Barrett, Brit. surgeon, 1903-1979]
A metaplastic lesion of the lower esophagus that may predispose patients to dysplasia or adenocarcinoma.

In autopsy studies, between 0.3% and 1.0% of all people die with some degree of metaplasia in the lower esophagus. Among patients with gastroesophageal reflux disease, the incidence of Barrett esophagus is between 10% and 20%.

Barrett esophagus is diagnosed with endoscopy of the upper gastrointestinal tract.

Barrett esophagus is caused by injury to the squamous epithelium of the distal esophagus by acid reflux, eventually causing the squamous epithelium to be replaced by metaplastic columnar epithelium.

The patient experiences symptoms relating to acid reflux or hiatal hernia, but not to the epithelial changes per se.

Medications for acid reflux include H2-receptor antagonists (famotidine) or proton pump inhibitors (omeprazole).

Barrett esophagus may be a precursor to adenocarcinoma of the esophagus, a deadly cancer, in a small percentage of patients. The likelihood of developing esophageal cancer is greatest in males over the age of 50 who have known hiatal hernia and no sign of infection with Helicobacter pylori. In most patients, Barrett esophagus can be controlled or arrested with appropriate medical treatment.

Patients with Barrett esophagus, who have concerning symptoms or findings (iron-deficiency anemia; dysphagia; vomiting after meals; weight loss) should undergo repeat endoscopy to exclude strictures, esophagitis, or cancer. In patients without alarming signs or symptoms, patient education should emphasize the need for repeat endoscopy as recommended by contemporary guidelines, e.g., once every 3 to 5 years.

SEE: gastroesophageal reflux disease