9.5 : Barrett Esophagus-I: Introduction

Barrett's esophagus is a medical condition where the esophageal mucosa is significantly damaged by stomach acid or other digestive fluids, often due to long-term exposure associated with gastroesophageal reflux disease (GERD). In GERD, a weakened or abnormally relaxed lower esophageal sphincter allows stomach acid to flow persistently into the esophagus.

This constant acid exposure transforms the esophagus's pink mucosal lining (stratified squamous epithelium) into a type of lining more similar to the intestines, with simple columnar epithelium and goblet-like cells. This process, known as metaplasia, is the body's defensive response to prevent further damage.

In addition, Barrett's esophagus can involve dysplasia, where tissue and cells exhibit atypical growth and development. Advanced dysplasia can progress to adenocarcinoma, a form of esophageal cancer. As a result, regular monitoring is crucial for individuals with Barrett's esophagus.

Patients with GERD are monitored for Barrett's esophagus primarily through upper endoscopy (esophagogastroduodenoscopy or EGD), especially if they have risk factors such as chronic GERD symptoms, obesity, smoking, male gender, or being over 50 years old.

If Barrett's esophagus is detected, further biopsies are performed to assess for the presence and severity of dysplasia. Regular surveillance schedules are then established based on the findings:

1. No Dysplasia: Endoscopy every 3-5 years.
2. Low-Grade Dysplasia: Endoscopy every 6-12 months or endoscopic therapy.
3. High-Grade Dysplasia: Close monitoring with frequent endoscopies or definitive treatments like radiofrequency ablation or esophagectomy.

Additional risk factors for Barrett's esophagus include obesity, smoking, alcohol consumption, genetic predisposition, chronic use of aspirin or anti-inflammatory drugs, and being a white male over 50 years old.

Recognizing the complexities and cancer risks associated with Barrett's esophagus underscores the importance of early detection, effective management, and lifestyle changes. Regular medical check-ups and healthy habits are essential in minimizing the complications associated with Barrett's esophagus.