Barretts oesophagus

Cardiothoracic Surgery..!!

1. BARRETTS OESOPHAGUS
By:
SharminSusiwala
TY BPT

2. INTRODUCTION:
Barrett esophagussometimes calledBarrett
syndromeorcolumnar epithelium lined lower
oesophagus(CELLO), refers to an abnormal change
(metaplasia) in the cells of the lower portion of
theesophagus.
When the normalsquamous epitheliumlining of the
esophagus is replaced bygoblet cells(cells usually found
lower in the gastrointestinal tract), Barrett's esophagus is
diagnosed.
The medical significance of Barrett esophagus is its strong
association with esophagealadenocarcinoma, a particularly
lethal cancer.

3. CAUSES:
An adaptation to chronic acid exposure
fromreflux esophagitis
Gastroesophageal reflux disease GERD

4. SIGNS AND SYMPTOMS:
The change from normal to premalignant cells that indicate Barrett
esophagus does not cause any particular symptoms.
Barrett esophagus, however, is associated with the following symptoms:
frequent and longstandingheartburn
trouble swallowing (dysphagia)
vomiting blood (hematemesis)
pain under the breastbone where the esophagus meets the stomach
unintentional weight loss because eating is painful
The risk of developing Barrett esophagus is increased bycentral
obesity(vs. peripheral obesity).

5. MECHANISM
Barrett esophagus occurs due to chronic inflammation.
The principal cause of the chronic inflammation is GERD.
In this disease, acidic stomach, bile, small intestine and
pancreatic contents cause damage to the cells of the lower
esophagus.
Recently, it was shown thatbile acidsare able to induce
intestinal differentiation, in gastroesophageal junction cells,
through inhibition of theEpidermal growth factor receptor
(EGFR) receptor and theprotein kinaseenzymeAkt.

6. DIAGNOSIS:
Diagnosis of Barrett esophagus requiresendoscopy (more
specifically,esophagogastroduodenoscopy, a procedure in which a
fibre optic cable is inserted through the mouth to examine the
esophagus, stomach, andduodenum) andbiopsy.
Barrett esophagus is marked by the presence ofcolumnar
epitheliain the lower esophagus, replacing the normalsquamous
cellepithelium—an example ofmetaplasia
The cells of Barrett esophagus, after biopsy, are classified into four
general categories:
1.non-dysplastic
2.low-gradedysplasia
3.high-grade dysplasia
4.frankcarcinoma
5.High-grade dysplasia

7. MANAGEMENT:
Treatment options for high-grade dysplasia include:
-surgical removal of the esophagus (esophagectomy)
-endoscopic treatments such asendoscopic mucosal resectionor
radiofrequency ablation (destruction).
Proton pump inhibitor drugs have not yet been proven to prevent
esophageal cancer.
Laser treatmentis used in severe dysplasia, while overt malignancy may
requiresurgery,radiation therapy, or systemicchemotherapy.
Endoscopic mucosal resection(EMR) has also been evaluated as a
management technique.Additionally an operation known as aNissen
fundoplicationcan reduce the reflux of acid from the stomach into the
esophagus.
In a variety of studies, non-steroidal anti-inflammatory drugs (NSAIDS),
likeaspirin, have shown evidence of preventing esophageal cancer in
Barrett esophagus patients.