Endoscopic Management of Barrett’s Esophagus
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Abstract:
Barrett's esophagus (BE) is a well-recognized premalignant condition for development of esophageal adenocarcinoma (EAC). It is defined as the displacement of the squamo-columnar junction proximal to the gastroesophageal junction, with the presence of intestinal metaplasia (IM) on biopsies (Wang and Sampliner 2008; Sharma et al. 2004). Chronic gastroesophageal reflux disease (GERD) is the most frequent identifiable risk factor for Barrett's esophagus (Wang and Sampliner 2008; Sharma et al. 2004). In Western populations, BE may be present in approximately 0.4–1.6% of adults, whereas in patients with chronic GERD, the prevalence is approximately 10–15% (Pondugula et al. 2007; Wani and Sharma 2007a). The frequency of EAC in the United States is gradually rising. It has been estimated that 14,550 new cases of esophageal cancer were diagnosed in 2006, with 13,770 deaths related to esophageal cancer, the majority diagnosed at an advanced stage (American Cancer Society 2006). Barrett's esophagus is considered to be one of the most important identifiable risk factors leading to development of EAC (Menke-Pluymers et al. 1993; Solaymani-Dodaran et al. 2004). Progression of BE to esophageal cancer involves a series of pathological changes, from early nondysplastic columnar epithelium (ND BE) to low-grade dysplasia (LGD), high-grade dysplasia (HGD), and finally to cancer. The mortality associated with EAC is high, with a 5-year survival rate of only 15% (Pondugula et al.2007; Cossentino and Wong 2003; Devesa et al.1998).Keywords:
Intestinal metaplasia
Barrett's esophagus
Metaplasia
Barrett's esophagus (BE) is one of the complications of gastroesophageal reflux disease (GERD) and a premalignant condition. It consists of a process of replacement of the squamous epithelium of the esophagus by intestinal columnar epithelium containing goblet cells, known as specialized intestinal metaplasia with goblet cells, and several factors have been related to its pathogenesis. The objective of this study was to evaluate an experimental model of duodenogastroesophageal reflux and the effect of ingestion of sodium nitrite solution on the genesis of adenocarcinoma associated with Barrett's esophagus.Sixty male Wistar rats were divided into four groups. Twenty were not submitted to surgery and served as controls (10 animals ingesting only water and 10 ingesting water plus a solution of sodium nitrite), while the remaining 40 animals were submitted to side-to-side duodenogastroesophageal anastomosis (20 animals ingesting only water and 20 ingesting water plus the sodium nitrite solution). The Vienna classification for dysplasia and adenocarcinoma was used in the analysis of results.After 42 weeks of observation, Barrett's esophagus was found in 26.3% (5/19) of the animals submitted to surgery that had not ingested nitrites compared to 72.3% (13/18) of the animals in the group submitted to surgery and given nitrites. Six cases of adenocarcinoma (33.3%) were also found in this latter group. Barrett's esophagus was not found in any of the animals that were not submitted to surgery. Categories 2, 3 and 5 of the Vienna classification were only found in the animals submitted to surgery that also received sodium nitrite (66.7%).The ingestion of sodium nitrite associated with duodenogastroesophageal reflux plays an important role in the genesis of adenocarcinoma associated with Barrett's esophagus.
Intestinal metaplasia
Barrett's esophagus
Metaplasia
Sodium nitrite
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To study the prevalence of Barrett's esophagus in Chinese and its correlation with gastroesophageal reflux.This study was carried out in a large prospective series of 391 patients who had undergone upper endoscopy. The patients were divided into 3 groups according to the position of squamocolumnar junction (SCJ). Reflux esophagitis (RE) and its degree were recorded. Intestinal metaplasia (IM) in biopsy specimen was typed according to histochemistry and HE and alcian blue (pH2.5) staining separately. Results correlating with clinical, endoscopic, and pathological data were analysed.The prevalence of IM endoscopically appearing Long-segment Barrett's Esophagus (LSBE) was 26.53%, Short-segment Barrett's Esophagus (SSBE) was 33.85% and gastroesophageal junction (GEJ) was 34.00%. IM increased with age of above 40 years old and no difference was found between male and female. Twelve were diagnosed as dysplasia (7 low-grade, 5 high-grade), 16 were diagnosed as cardiac adenocarcinoma and 1 as esophageal adenocarcinoma. The more far away the SCJ moved upward above GEJ, the higher the prevalence and the more severe the RE were.There was no difference of the prevalence of IM in different places of SCJ, and IM increased with age of above 40 years old. It is important to pay attention to dysplasia in the distal esophagus and gastro-esophageal junction, and adenocarcinoma is more common in cardia than in esophagus. BE is a consequence of gastroesophageal reflux disease.
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Barrett's esophagus
Reflux esophagitis
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Esophagitis
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AIM- To study the prevalence of Barrett's esophagus in Chinese and its correlation with gastroesophageal reflux. METHODS: This study was carded out in a large prospective series of 391 patients who had undergone upper endoscopy. The patients were divided into 3 groups according to the position of squamocolumnar junction (SC3). Reflux esophagitis (RE) and its degree were recorded. Intestinal metaplasia (IM) in biopsy specimen was typed according to histochemistry and HE and alcian blue (pH2.5) staining separately. Results correlating with clinical, endoscopic, and pathological data were analysed. RESULTS: The prevalence of IM endoscopically appearing Long-segment Barrett's Esophagus (LSBE) was 26.53%, Short-segment Barrett's Esophagus (SSBE) was 33.85% and gastroesophageal junction (GEJ) was 34.00%. IM increased with age of above 40 years old and no difference was found between male and female. Twelve were diagnosed as dysplasia (7 low -grade, 5 high-grade), 16 were diagnosed as cardiac adenocarcinoma and 1 as esophageal adenocarcinoma. The more far away the SCJ moved upward above GEJ, the higher the prevalence and the more severe the RE were. CONCLUSION: There was no difference of the prevalence of IM in different places of SCJ, and IM increased with age of above 40 years old. It is important to pay attention to dysplasia in the distal esophagus and gastro-esophageal junction, and adenocarcinoma is more common in cardia than in esophagus. BE is a consequence of gastroesophageal reflux disease.
Intestinal metaplasia
Barrett's esophagus
Reflux esophagitis
Metaplasia
Esophagitis
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Barrett’s esophagus (BE), as a more frequent complication of gastroesophageal reflux disease, is a metaplastic condition in which the normal squamous epithelium of the esophagus is replaced by specialized intestinal metaplastic epithelium, and that, in about 10% of patients with gastroesophageal reflux disease (GERD) and the main condition for dysplasia and adenocarcinoma. The incidence of adenocarcinoma of the cardia is rapidly increasing at a rate that exceeds that of any other cancer. Recently, acid suppression with proton pump inhibitors (PPIs) has become the cornerstone of treatment for patients with BE. Many worldwide investigations showed that PPI is effective in the regression of BE with low-grade dysplasia and especially for the regression of intestinal metaplasia, incomplete or complete, for long-term use of these medicaments. This chapter reviews the specific endpoints of such treatment, included and our results for this dilemma.
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Barrett's esophagus
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Barrett's esophagus
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Metaplasia
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Barrett's esophagus
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Although the pathogenesis of cervical inlet patch (CIP) is not fully understood, most authors consider it as a congenital abnormality, whereas others surmise it to be related to gastroesophageal reflux disease (GERD). We aimed to evaluate esophageal function and the prevalence of GERD and Barrett's esophagus in patients with CIP. GERD is defined by the presence of erosive esophagitis or an abnormal pH monitoring. Seventy-one consecutive patients with endoscopic and histological evidence of CIP were prospectively evaluated. Esophageal symptom analysis, 24-hour simultaneous biliary reflux and double-channel pH-monitoring, and esophageal manometry were carried out in 65/71 (92%) patients and in 25 matched controls. Six patients were not suitable for testing and were, therefore, excluded. The histological evaluation of the heterotopic islands showed cardia and/or oxyntic mucosa in 64/65 (98%) patients and specialized intestinal metaplasia (SIM) in one patient (2%). The cardia and/or oxyntic mucosa was accompanied by focally appearing pancreatic acinar metaplasia and pancreatic ductal metaplasia in 7/64 (11%) and in 1/64 (2%), superficial mucous glands in 6/64 (9%), and SIM in 2/64 (3%) cases. In total, SIM was present in three patients (5%), and one of them had low-grade dysplasia. At the gastroesophageal junction, 28 (43%) patients had columnar metaplasia, including nine (14%) patients with SIM. Erosive esophagitis was present in 37 (57%) cases. Thirty-two patients (49%) had abnormal acid reflux in the distal and 25 (38%) in the proximal esophagus. Abnormal biliary reflux was present in 25 (38%) cases. On the basis of endoscopic and pH studies, GERD was established in 44/65 (68%) patients. Typical reflux symptoms were common (33/65, 51%). The combined 24-hour biliary and double-channel pH-monitoring detected significantly more significant acidic reflux at both measurement points and significantly longer bile exposure time in the distal esophagus in patients with CIP. Acid secretion in the CIP was detected in three (5%) cases. Esophageal manometry revealed decreased LES pressure and prolonged relaxation with decreased peristaltic wave amplitude, and an increased number of simultaneous contractions in the esophageal body. The detailed evaluation of the esophageal morphology and function in subjects with CIP showed a high prevalence of GERD and Barrett's esophagus. Further studies are needed to evaluate whether combined acidic and biliary reflux is able to promote similar histomorphological changes in the CIP, as it is shown distally in patients with Barrett's esophagus.
Intestinal metaplasia
Metaplasia
Barrett's esophagus
Esophagitis
Reflux esophagitis
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Metaplasia
Barrett's esophagus
Esophageal adenocarcinoma
Intestinal metaplasia
Malignant Transformation
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