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Encyclopedia > Barrett's esophagus
Barrett's esophagus
Classification & external resources
Endoscopic image of Barrett's esophagus, which is the area of red mucosa projecting like a tongue. Biopsies showed intestinal metaplasia.
ICD-10 K22.7
ICD-9 530.85
OMIM 109350
DiseasesDB 1246
MedlinePlus 001143
eMedicine radio/73 

Barrett's esophagus (sometimes called Barrett's syndrome, CELLO, columnar epithelium lined lower (o)esophagus or colloquially as Barrett's) refers to an abnormal change (metaplasia) in the cells of the lower end of the esophagus thought to be caused by damage from chronic acid exposure, or reflux esophagitis.[1] Barrett's esophagus is found in about 10% of patients who seek medical care for heartburn (gastroesophageal reflux). It is considered to be a premalignant condition and is associated with an increased risk of esophageal cancer.[2] Image File history File linksMetadata Barretts_esophagus. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Metaplasia is the replacement of one differentiated cell type with another differentiated cell type. ... The esophagus (also spelled oesophagus/œsophagus, Greek ), or gullet is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. ... Esophagitis (aka reflux esophagitis) is inflammation of the esophagus. ... Gastroesophageal Reflux Disease (GERD, or GORD when -oesophageal, the BE form, is substituted) is injury to the esophagus that develops from chronic exposure of the esophagus to acid coming up from the stomach (reflux). ... A premalignant condition is a disease, syndrome, or finding that, if left untreated, may lead to cancer. ... Esophageal cancer is malignancy of the esophagus. ...


The condition is named after Dr. Norman Barrett (19031979), Australian-born British surgeon at St Thomas' Hospital, who described the condition in 1957.[3] 1900 (MCMIII) was a common year starting on Thursday (link will display calendar) of the Gregorian calendar or a common year starting on Friday of the 13-day slower Julian calendar. ... Also: 1979 by Smashing Pumpkins. ... Saint Thomas’ Hospital. ... Year 1957 (MCMLVII) was a common year starting on Tuesday (link displays the 1957 Gregorian calendar). ...

Contents

Pathology

Barrett's esophagus is marked by the presence of columnar epithelia in the lower esophagus, replacing the normal squamous cell epithelium—an example of metaplasia. The columnar epithelium is better able to withstand the erosive action of the gastric secretions; however, this metaplasia confers an increased cancer risk of the adenocarcinoma type.[4] Columnar epithelia are cells whose heights are at least twice their width. ... Squamous cells are basically types of cells which can be identified histologically by the fact that they look flattened and thin under a microscope. ... Adenocarcinoma is a form of carcinoma that originates in glandular tissue. ...


The metaplastic columnar cells may be of two types: gastric (similar to those in the stomach, which is NOT technically Barrett's esophagus) or colonic (similar to cells in the intestines). A biopsy of the affected area will often contain a mixture of the two. Colonic-type metaplasia confers a higher risk of malignancy. In anatomy, the stomach is a bean-shaped hollow muscular organ of the gastrointestinal tract involved in the second phase of digestion, following mastication. ... In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine (or colon). ...


The metaplasia of Barrett's esophagus is visible grossly through a gastroscope, but biopsy specimens must be examined under a microscope to determine whether cells are gastric or colonic in nature. Colonic metaplasia is usually identified by finding goblet cells in the epithelium and is necessary for the true diagnosis of Barrett's. In medicine (gastroenterology), esophagogastroduodenoscopy (EGD) or upper endoscopy is a diagnostic endoscopic procedure that visualises the upper part of the gastrointestinal tract. ... Robert Hookes microscope (1665) - an engineered device used to study living systems. ... Goblet cells are glandular epithelial cells that are specifically designed to secrete mucus. ...


Dr. O. Arthur Stiennon has suggested that Barrett's esophagus may actually be a variety of hiatus hernia[5] Dr. O. Arthur Stiennon, Jr. ... A hiatus hernia or hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm. ...


Treatment

Current recommendations include routine endoscopy and biopsy (looking for dysplastic changes) every 12 months or so while the underlying reflux is controlled with proton pump inhibitor drugs in combination with measures to prevent reflux. In severe dysplasia, laser treatment is being used, whereas overt malignancy may require surgery, radiation therapy, or systemic chemotherapy. There is presently no reliable way to determine which patients with Barrett's esophagus will go on to develop esophageal cancer. Endoscopic mucosal resection (EMR) has also been evaluated as a management technique.[6] Endoscopic images of a duodenal ulcer A flexible endoscope. ... Brain biopsy A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... Dysplasia (latin for bad form) is an abnormality in the appearance of cells indicative of an early step towards transformation into a neoplasia. ... Proton pump inhibitors (or PPIs) are a group of drugs whose main action is pronounced and long-lasting reduction of gastric acid production. ... Lasers were used in the 2005 Classical Spectacular concert Soon after the invention of the laser in 1960, it was described as a solution in search of a problem. However, since that time, the laser has found a place as a useful tool in many scientific, military, medical and industrial... “Surgeon” redirects here. ... Clinac 2100 C100 accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... Chemotherapy is the use of chemical substances to treat disease. ...


Additionally an operation known as a Nissen fundoplication can reduce the reflux of acid from the stomach into the esophagus.[7] This article or section does not cite its references or sources. ...


Recent data has shown that recurrent bouts of steatorrhoea increase the likelihood of developing Barrett's Anus, a metaplastic change in the distal rectum. The loose, foul-smelling and frequently acidic stools associated with malabsorption of fat promote the development of an unusually untoward and erratic epithelium. Barrett's anus is the only known predecessor of squamous cell carcinoma of the rectum and the devastating Anal Teratoma of Langerhans.


References

  1. ^ Stein H, Siewert J (1993). "Barrett's esophagus: pathogenesis, epidemiology, functional abnormalities, malignant degeneration, and surgical management". Dysphagia 8 (3): 276-88. PMID 8359051. 
  2. ^ Koppert L, Wijnhoven B, van Dekken H, Tilanus H, Dinjens W (2005). "The molecular biology of esophageal adenocarcinoma". J Surg Oncol 92 (3): 169-90. PMID 16299787. 
  3. ^ Barrett N (1957). "The lower esophagus lined by columnar epithelium". Surgery 41 (6): 881-94. PMID 13442856. 
  4. ^ Fléjou J (2005). "Barrett's oesophagus: from metaplasia to dysplasia and cancer". Gut 54 Suppl 1: i6-12. PMID 15711008. 
  5. ^ The Longitudinal Muscle in Esophageal Disease
  6. ^ Reshamwala P, Darwin P (2006). "Endoscopic management of early gastric cancer". Curr Opin Gastroenterol 22 (5): 541-5. PMID 16891887. 
  7. ^ Novitsky Y, Paton B, Kercher K, Heniford B (2006). "Current aspects of surgical management of GERD". Surg Technol Int 15: 53-62. PMID 17029162. 

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