Andrea M.

Nieves Ortiz May 13, 2021

4558565
Surgery Clerkship: assignment #6

Barret Esophagus

Cause of the disease

The Barret esophagus it’s a condition that it’s characterized by the conversion of the normal
esophageal squamous epithelium into metaplastic columnar epithelium. This specialized
columnar epithelium serves a protective function, as it is more resistant to stomach acid
Most of the cases is by long standing gastroesophageal reflux. The Barret esophagus is a
premalignant condition but can develop into esophageal adenocarcinoma. (1,2)

Common sign and symptoms

Patient should be present retrosternal burning sensation especially after eating, acid
regurgitation. Other symptoms that can present is dysphagia and globus sensation. (1)

Pathophysiology
The exact pathogenesis is unknown, but some progresses are associated with molecular
alterations and primary cell type involved. Exposure to acid should be induce the squamous
epithelial cells to secrete inflammatory cytokines such as IL8 and IL1b which act mediate the
inflammatory response and signal T lymphocytes and neutrophils. CDX2 and TP53 mutation are
early molecular alteration found to be present in metaplastic columnar epithelium. More than
90% of this patient have a detectable clonal aberration of p16. A decrease in lower esophageal
sphincter tone increases the reflux of acidic and bile in the distal esophagus. (1,2)

Diagnostic criteria
The American college of Gastroenterology recommend screening for Barret esophagus in men at
least 5 years of chronic GERD symptoms, additional risk factors are older than 50 years, history
of smoking, white ethnicity, and central obesity. Endoscopic for identify columnar metaplasia
describe as “salmon-pink” tongues of mucosal tissue, pathological confirmation of intestinal
metaplasia with goblet cells on biopsy.
Treatment
The patient should also be placed on once-daily proton pump inhibitor therapy, regardless of the
presence of reflux symptoms due to evidence of a chemo preventive effect of proton pump
inhibitors, where the risk of progression to neoplastic Barret esophagus is reduced compared to
no acid suppression or H2 blockers.  Patients with confirmed low-grade dysplasia its
recommended for endoscopic ablative therapy or can follow a 6 to 12-month interval
surveillance plan. For patients with confirmed high-grade dysplasia with endoscopic mucosal
abnormalities, endoscopic mucosal resection followed by ablation of the remaining BE mucosa
is recommended.  If no mucosal abnormality is visible, in other words, the mucosa is flat;
radiofrequency ablation therapy is considered sufficient for low- or high-grade dysplasia as well
as carcinoma.  The role of diet in the treatment is useful and is recommended that patients lower
the intake of meat. In addition, patients should avoid oily foods, alcohol, caffeinated beverages,
chocolate, acidic juices, vinegar, and carbonated drinks.(1)

Prognosis
The outcome reporting in Barret esophagus is good to excellent but If the Barret esophagus if left
untreated should be develop into adenocarcinoma. Risk of progression is slow and most patient
will not develop a malignancy. (1)

References

1. Khieu, M. (2020, August 10). Barrett esophagus. Retrieved May 14, 2021, from
https://www.ncbi.nlm.nih.gov/books/NBK430979/

2. Lowe, D. (2021, January 07). Barrett metaplasia. Retrieved May 14, 2021, from
https://www.ncbi.nlm.nih.gov/books/NBK459330/