Then after that, you take the appropriate
steps to properly manage your
patient with GERD because you are
worried about Barrett’s esophagus.
Barrett’s esophagus would be the beginning stages or excuse me,
it would be the confirmation that metaplasia is taking place.
But this is not cancer, is it?
So this is reversible?
That is correct.
Lifestyle modifications could
reverse the metaplasia.
So what is Barrett’s esophagus?
It is replacement of the normal histology of the esophagus,
which is squamous and because of the reflux, I understand
that the esophagus wants to do everything in its power to
protect itself against the reflux of this
acid with a pH of 2.0
You cannot do this
with squamous cells.
So you have metaplasia into columnar,
associated with long term acid exposure.
And as the Barrett’s esophagus persists, and the
reflux is not properly controlled, you are in fact
worried about dysplasia and worst case scenario;
you’re worried about developing adenocarcinoma.
Down in the distal esophagus.
What kind of dysphagia would this be?
It would be progressive
solids first, then liquids.
Treatment for Barrett’s usually consists of long-term acid suppression through
an indefinite usage of a PPI, though it should be noted that research evidence
does not show this lowering the risk of cancer.
Additionally, patients with Barret’s should be closely followed with regular endoscopy,
and may require other procedures such as endoscopic ablations.
Let’s take a look at
You’ll notice on the left here, that the areas
that are more reddish or erythematous,
will be areas in which there was reflux taking place
and there’s inflammation of the esophagus.
It looks rather coarse in nature.
And on the right, you’ll notice now
that these are Barrett tongues.
Mean to say that you have replacement of your squamous,
which is more or less on the perimeter
of this endoscopic examination.
And the middle would be more of
your columnar type of metaplasia.
You do not have the smooth type
of histology that you would expect
with uniform nature of your esophagus,
in both of these instances.