Barrett's Esophagus

Barrett's Esophagus

Barrett esophagus (British English: Barrett's oesophagus), sometimes called Barrett syndrome or columnar epithelium lined lower oesophagus (CELLO), refers to an abnormal change (metaplasia) in the cells of the inferior portion of the esophagus. A positive diagnosis generally requires observing specific macroscopic and microscopic changes. The normal squamous epithelium lining of the esophagus is replaced by metaplastic columnar and goblet cells. Columnar epithelium refers to a cell type that is typically found in more distal parts of the gastrointestinal system. Only the presence of goblet cells equates a diagnosis of Barrett esophagus. The medical significance of Barrett esophagus is its strong association with esophageal adenocarcinoma, a particularly lethal cancer.

The main cause of Barrett esophagus is thought to be an adaptation to chronic acid exposure from reflux esophagitis. In the last 4 years, the incidence of esophageal adenocarcinoma has been increasing in the Western world. Barrett esophagus is found in 5–15% of patients who seek medical care for heartburn (gastroesophageal reflux disease, GERD), although a large subgroup of patients with Barrett esophagus do not have symptoms. It is considered to be a premalignant condition because it is associated with an increased risk of esophageal cancer (more specifically, adenocarcinoma) of about 0.5% per patient-year. If the cancer develops, it is very often deadly. Diagnosis of Barrett esophagus requires endoscopy (more specifically, esophagogastroduodenoscopy, a procedure in which a fibre optic cable is inserted through the mouth to examine the esophagus, stomach, and duodenum) and biopsy. The cells of Barrett esophagus, after biopsy, are classified into four general categories: non-dysplastic, low-grade dysplasia, high-grade dysplasia, and frank carcinoma. High-grade dysplasia and early stages of adenocarcinoma can be treated by endoscopic resection and new endoscopic therapies such as radiofrequency ablation, whereas advanced stages (submucosal)are generally advised to undergo surgical treatment. Non-dysplastic and low-grade patients are generally advised to undergo annual observation with endoscopy, with radiofrequency ablation as a therapeutic option. In high-grade dysplasia, the risk of developing cancer might be at 10% per patient-year or greater.

The condition is named after Norman Barrett (1903–1979) who described the condition in 1950.