A report on Barrett's esophagus

Endoscopic image of Barrett's esophagus, which is the area of dark reddish-brown mucosa at the base of the
                   esophagus. (Biopsies showed intestinal metaplasia.)
Histopathology of Barrett's esophagus, showing intestinalized epithelium with goblet cells, as opposed to normal stratified squamous epithelium of the esophagus, and pseudostratified columnar epithelium of the fundus of the stomach. The submucosa displays an infiltrate including lymphocytes and plasma cells, constituting an underlying chronic inflammation. The area between the stratified and the intestinalized epithelium displays reactive changes, but there is no secondary dysplasia in this case. H&E stain.
In incomplete Barrett's esophagus, there are both foveolar cells and goblet cells, the latter (indicated by arrows) usually having a slightly bluish color compared to the apical cytoplasm of foveolar cells on H&E stain. An occasional but specific sign of goblet cells is crescent shaped nuclei (seen in middle one).
Micrograph showing Barrett's esophagus - columnar epithelia with goblet cells - on the left side of image; and normal stratified squamous epithelium on the right side of image Alcian blue stain
High-magnification micrograph of Barrett's esophagus showing the characteristic goblet cells, Alcian blue stain
Endoscopic view of Barrett's esophagus showing location of biopsies for screening using the Seattle protocol
Barrettʼs cancer adenocarcinoma (poor; signet-ringcell)

Condition in which there is an abnormal change in the mucosal cells lining the lower portion of the esophagus, from stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells that are normally present only in the small intestine and large intestine.

- Barrett's esophagus
Endoscopic image of Barrett's esophagus, which is the area of dark reddish-brown mucosa at the base of the
                   esophagus. (Biopsies showed intestinal metaplasia.)

18 related topics with Alpha

Overall

Endoscopic image of an esophageal adenocarcinoma

Esophageal cancer

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Cancer arising from the esophagus—the food pipe that runs between the throat and the stomach.

Cancer arising from the esophagus—the food pipe that runs between the throat and the stomach.

Endoscopic image of an esophageal adenocarcinoma
Esophageal cancer (lower part) as a result of Barrettʼs esophagus
Esophageal cancer as shown by a filling defect during an upper GI series
Esophageal stent for esophageal cancer
Esophageal stent for esophageal cancer
Before and after a total esophagectomy
Typical scar lines after the two main methods of surgery
Death from esophageal cancer per million persons in 2012
Endoscopic image of Barrett esophagus – a frequent precursor of esophageal adenocarcinoma
Endoscopy and radial endoscopic ultrasound images of a submucosal tumor in the central portion of the esophagus
Contrast CT scan showing an esophageal tumor (axial view)
Contrast CT scan showing an esophageal tumor (coronal view)
Esophageal cancer
Micrograph showing histopathological appearance of an esophageal adenocarcinoma (dark blue – upper-left of image) and normal squamous epithelium (upper-right of image) at H&E staining
T1, T2, and T3 stages of esophageal cancer
Stage T4 esophageal cancer
Esophageal cancer with spread to lymph nodes
Internal radiotherapy for esophageal cancer
Self-expandable metallic stents are sometimes used for palliative care

Adenocarcinoma arises from glandular cells present in the lower third of the esophagus, often where they have already transformed to intestinal cell type (a condition known as Barrett's esophagus).

X-ray showing radiocontrast from the stomach (white material below diaphragm) entering the esophagus (three vertical collections of white material in the mid-line of the chest) due to severe reflux

Gastroesophageal reflux disease

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Chronic condition in which stomach contents and acid rise up into the esophagus, resulting in symptoms and/or complications.

Chronic condition in which stomach contents and acid rise up into the esophagus, resulting in symptoms and/or complications.

X-ray showing radiocontrast from the stomach (white material below diaphragm) entering the esophagus (three vertical collections of white material in the mid-line of the chest) due to severe reflux
Frontal view of severe tooth erosion in GERD.
Severe tooth erosion in GERD.
A comparison of a healthy condition to GERD
Endoscopic image of peptic stricture, or narrowing of the esophagus near the junction with the stomach: This is a complication of chronic gastroesophageal reflux disease and can be a cause of dysphagia or difficulty swallowing.

Complications include esophagitis, esophageal stricture, and Barrett's esophagus.

The digestive tract, with the esophagus marked in red

Esophagus

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Organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the stomach.

Organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the stomach.

The digestive tract, with the esophagus marked in red
The esophagus is constricted in three places.
A mass seen during an endoscopy and an ultrasound of the mass conducted during the endoscopy session.

Normally, the cardia of the stomach is immediately distal to the z-line and the z-line coincides with the upper limit of the gastric folds of the cardia; however, when the anatomy of the mucosa is distorted in Barrett's esophagus the true gastro-eshophageal junction can be identified by the upper limit of the gastric folds rather than the mucosal transition.

Heartburn

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Burning sensation in the central chest or upper central abdomen.

Burning sensation in the central chest or upper central abdomen.

Endoscopy looking for erosive changes of the esophagus consistent with prolonged acid exposure (e.g. - Barrett's esophagus)

An example of an endoscopic procedure

Endoscopy

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Procedure used in medicine to look inside the body.

Procedure used in medicine to look inside the body.

An example of an endoscopic procedure
Operation part of the endoscope
Insertion tip of endoscope
An anoscope, a proctoscope, and a rectoscope with approximate lengths
Endoscopy surgery
Drawings of Bozzini's "Lichtleiter", an early endoscope
A Storz endoscopy unit used for laryngoscopy exams of the vocal folds and the glottis
Low-cost waterproof USB endoscope for non-medical use.

Specialty professional organizations that specialize in digestive problems advise that many patients with Barrett's esophagus receive endoscopies too frequently.

General structure of a proton-pump inhibitor

Proton-pump inhibitor

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Proton-pump inhibitors (PPIs) are a class of medications that cause a profound and prolonged reduction of stomach acid production.

Proton-pump inhibitors (PPIs) are a class of medications that cause a profound and prolonged reduction of stomach acid production.

General structure of a proton-pump inhibitor
The activation of PPIs

Barrett's esophagus

Diagram of a Nissen fundoplication.

Nissen fundoplication

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Surgical procedure to treat gastroesophageal reflux disease and hiatal hernia.

Surgical procedure to treat gastroesophageal reflux disease and hiatal hernia.

Diagram of a Nissen fundoplication.
A completed Nissen fundoplication

Presence of Barrett's esophagus is not an indication, as the benefit of a fundoplication in preventing progression into adenocarcinoma is controversial.

Norman Barrett

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Norman Rupert Barrett (16 May 1903 – 8 January 1979) was an Australian-born British thoracic surgeon who is widely yet mistakenly remembered for describing what became known as Barrett's oesophagus.

Endoscopic still of esophageal ulcers seen after banding of esophageal varices, at time of esophagogastroduodenoscopy

Esophagogastroduodenoscopy

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Diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum.

Diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum.

Endoscopic still of esophageal ulcers seen after banding of esophageal varices, at time of esophagogastroduodenoscopy
Gastroscopy or duodenoscopy is performed for a number of indications, one of the most common being in unexplained anemia, where it is used to diagnose gastric or duodenal ulcers, among other things.
Indigo carmine staining (stomach)
Endoscopic image of adenocarcinoma of duodenum seen in the post-bulbar duodenum.
Endoscopic image of gastric antral vascular ectasia seen as a radial pattern around the pylorus before (top) and after (bottom) treatment with argon plasma coagulation
Endoscopic image of Barrett's esophagus, which is the area of red mucosa projecting like a tongue.
Deep gastric ulcer
Endoscopic still of duodenum of patient with celiac disease showing scalloping of folds.
Gastric ulcer in antrum of stomach with overlying clot due to gastric lymphoma.
Endoscopic image of a posterior wall duodenal ulcer with a clean base, which is a common cause of upper GI hemorrhage.
Endoscopic images of an early stage stomach cancer. 0-IIa, tub1. Left column: Normal light. Right column: computed image enhanced (FICE). First row: Normal. Second row: Acetate stained. Third row: Acetate-indigocarmine mixture (AIM) stained.

Heartburn and chronic acid reflux – this can lead to a precancerous lesion called Barrett's esophagus

Micrograph of a gastro-esophageal junction with pancreatic acinar metaplasia. The esophageal mucosa (stratified squamous epithelium) is seen on the right.  The gastric mucosa (simple columnar epithelium) is seen on the left. The metaplastic epithelium is at the junction (center of image) and has an intensely eosinophilic (bright pink) cytoplasm. H&E stain.

Metaplasia

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Transformation of one differentiated cell type to another differentiated cell type.

Transformation of one differentiated cell type to another differentiated cell type.

Micrograph of a gastro-esophageal junction with pancreatic acinar metaplasia. The esophageal mucosa (stratified squamous epithelium) is seen on the right.  The gastric mucosa (simple columnar epithelium) is seen on the left. The metaplastic epithelium is at the junction (center of image) and has an intensely eosinophilic (bright pink) cytoplasm. H&E stain.
A micrograph of Barrett's esophagus.

For example, there is evidence supporting several different hypotheses of origin in Barrett's esophagus.