Barrett's Esophagus-1


Esophagus: General
Esophagus: Structure
Esophagus: Function
Barrett's Esophagus-1
Barrett's Esophagus-2
Barrett's Esophagus-3
Photodynamic Therapy




Barrett esophagus is a precancerous condition that develops in up to 10% of patients who have of long-standing GERD.  Most of the patients with first diagnosis of Barrett esophagus are between the ages of 40 and 60, although children can occasionally develop this condition.  The highest incidence is among white males.  In addition to the symptoms of gastroesophageal reflux disease, Barrett esophagus is clinically significant due to the secondary complications of local ulceration with bleeding and stricture.  Barrett esophagus is the single most important risk factor for the development of esophageal adenocarcinoma; in fact patients diagnosed with Barrett’s disease have a 30-40 fold increase in risk.  Adenocarcinoma of the esophagus is associated with a very poor prognosis, with less than 20% over-all five year survival.

The pathogenesis of Barrett Esophagus is unclear, but it appears to result from an alteration in the differentiation program of stem cells of the esophageal mucosa (5).  The hallmark of Barrett esophagus is columnar metaplasia; a process in which the distal non-keratinized stratified squamous epithelium is replaced by metaplastic columnar epithelium as a response to prolonged mucosal injury.  It is hypothesized that initially the metaplasia is a protective process, allowing for the replacement of the acid damaged esophageal epithelium by that of gastric epithelium.  But like with any process that involves increased mitosis there is an increased risk of developing cancer. 





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