Barrett’s esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus: Anatomy is a chronic gastroesophageal reflux disease Gastroesophageal Reflux Disease Gastroesophageal reflux disease (GERD) occurs when the stomach acid frequently flows back into the esophagus. This backwash (acid reflux) can irritate the lining of the esophagus, causing symptoms such as retrosternal burning pain (heartburn). Gastroesophageal Reflux Disease (GERD) ( GERD GERD Gastroesophageal reflux disease (GERD) occurs when the stomach acid frequently flows back into the esophagus. This backwash (acid reflux) can irritate the lining of the esophagus, causing symptoms such as retrosternal burning pain (heartburn). Gastroesophageal Reflux Disease (GERD)) that leads to the replacement of stratified squamous epithelium Epithelium The epithelium is a complex of specialized cellular organizations arranged into sheets and lining cavities and covering the surfaces of the body. The cells exhibit polarity, having an apical and a basal pole. Structures important for the epithelial integrity and function involve the basement membrane, the semipermeable sheet on which the cells rest, and interdigitations, as well as cellular junctions. Surface Epithelium: Histology with gastric columnar epithelium Epithelium The epithelium is a complex of specialized cellular organizations arranged into sheets and lining cavities and covering the surfaces of the body. The cells exhibit polarity, having an apical and a basal pole. Structures important for the epithelial integrity and function involve the basement membrane, the semipermeable sheet on which the cells rest, and interdigitations, as well as cellular junctions. Surface Epithelium: Histology in the esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus: Anatomy. The condition is associated with an increased risk of esophageal adenocarcinoma Esophageal Adenocarcinoma Esophageal Cancer. Workup includes an esophagogastroduodenoscopy (EGD) showing proximal displacement Displacement The process by which an emotional or behavioral response that is appropriate for one situation appears in another situation for which it is inappropriate. Defense Mechanisms of the squamocolumnar junction Squamocolumnar junction Esophagus: Anatomy ( Z-line Z-line Esophagus: Anatomy) from the gastroesophageal junction Gastroesophageal junction The area covering the terminal portion of esophagus and the beginning of stomach at the cardiac orifice. Esophagus: Anatomy (GEJ). Biopsies will confirm the diagnosis by revealing columnar epithelium Epithelium The epithelium is a complex of specialized cellular organizations arranged into sheets and lining cavities and covering the surfaces of the body. The cells exhibit polarity, having an apical and a basal pole. Structures important for the epithelial integrity and function involve the basement membrane, the semipermeable sheet on which the cells rest, and interdigitations, as well as cellular junctions. Surface Epithelium: Histology and goblet cells Goblet cells A glandular epithelial cell or a unicellular gland. Goblet cells secrete mucus. They are scattered in the epithelial linings of many organs, especially the small intestine and the respiratory tract. Glandular Epithelium: Histology in the distal esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus: Anatomy. Treatment is primarily with proton pump Pump ACES and RUSH: Resuscitation Ultrasound Protocols inhibitors (PPIs) and lifestyle modifications. Surveillance Surveillance Developmental Milestones and Normal Growth with repeated EGD and biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma is necessary to monitor for early signs of dysplasia.
Last updated: Jul 11, 2022
Barrett’s esophagus metaplasia.
Schematic demonstrating the development of metaplasia after injury to the esophageal epithelium in Barrett’s esophagus. There are several proposed mechanisms.
A: Repair of reflux-induced injury leads to transdifferentiation of esophageal epithelial cells.
B: Repair of damaged tissue results from progenitor cells of the gastric cardia.
C: Repair of damaged tissue results from residual embryonic cell migration from the gastroesophageal junction or gastric cardia.
Screening Screening Preoperative Care:
Esophagogastroduodenoscopy (EGD):
Esophagogastroduodenoscopy revealing erythematous epithelium in the distal esophagus, consistent with Barrett’s esophagus. Notice the difference between the erythema of the columnar epithelium and the pale, glossy squamous epithelium. This junction is known as the Z-line.
Image: “Esophageal granular cell tumor colliding with intramucosal adenocarcinoma” by Alkhoury F, Martin JT, Fiedler P, Jaffe PE. License: CC BY 3.0Esophageal mucosal biopsy showing columnar epithelium and numerous goblet cells (light-blue cells), consistent with Barrett’s esophagus.
Image: “Barrett’s mucosa” by The Armed Forces Institute of Pathology (AFIP). License: Public DomainManagement goal is to treat underlying acid reflux to decrease the risk of cancer development.
Endoscopy Endoscopy Procedures of applying endoscopes for disease diagnosis and treatment. Endoscopy involves passing an optical instrument through a small incision in the skin i.e., percutaneous; or through a natural orifice and along natural body pathways such as the digestive tract; and/or through an incision in the wall of a tubular structure or organ, i.e. Transluminal, to examine or perform surgery on the interior parts of the body. Gastroesophageal Reflux Disease (GERD) biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma findings | Management |
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Barrett’s esophagus Esophagus The esophagus is a muscular tube-shaped organ of around 25 centimeters in length that connects the pharynx to the stomach. The organ extends from approximately the 6th cervical vertebra to the 11th thoracic vertebra and can be divided grossly into 3 parts: the cervical part, the thoracic part, and the abdominal part. Esophagus: Anatomy ( metaplasia Metaplasia A condition in which there is a change of one adult cell type to another similar adult cell type. Cellular Adaptation only) | PPIs and EGD every 2–3 years |
Low-grade dysplasia | PPIs and EGD every 6–12 months |
High-grade dysplasia | Endoscopic ablation or resection (endoscopic or surgical) |
Hematoxylin and eosin staining of esophageal mucosal biopsies.
A: non-dysplastic Barrett’s mucosa characterized by uniform, bland nuclei arranged in a surface monolayer
B: low-grade dysplasia exhibiting nuclear hyperchromasia, elongation, and stratification extending up to the surface epithelium
C: high-grade dysplasia depicting increased architectural and cytologic complexity, including loss of nuclear polarity
D: intramucosal adenocarcinoma characterized by severe architectural distortion, including angulated glands. (a–d, 100×)
Esophageal adenocarcinoma Esophageal Adenocarcinoma Esophageal Cancer is the most significant morbidity Morbidity The proportion of patients with a particular disease during a given year per given unit of population. Measures of Health Status.