Presentation of Barrett esophagus may be asymptomatic, but it typically occurs in middle-aged white men who have had chronic gastroesophageal reflux disease (GERD). Additional risk factors include tobacco use and obesity.
Cancer risk is determined by the degree of dysplasia.
Endoscopic screening and surveillance programs have multiple shortcomings. Screening of the general population is not recommended, and surveillance intervals vary depending on histologic findings.
Proton-pump inhibitors are commonly used to control GERD symptoms and may reduce the risk of neoplastic Barrett esophagus.
Endoscopic therapies play a central role in the management of dysplastic Barrett esophagus and early esophageal adenocarcinoma.
Barrett esophagus is a change in the normal squamous epithelium of the esophagus to specialized intestinal metaplasia. This is associated with gastroesophageal reflux, even if the reflux is asymptomatic. Essential to the diagnosis is histology demonstrating columnar-lined epithelium, with or without intestinal metaplasia and with goblet cells. Beyond gastroesophageal reflux-related symptoms, the main concern is the increased risk of adenocarcinoma of the esophagus.
History and exam
Key diagnostic factors
Other diagnostic factors
- chest pain
- Dyspnea or wheezing
- history of aspiration pneumonia
- acid/bile reflux or GERD
- increased age
- white ethnicity
- male sex
- family history of Barrett esophagus or esophageal adenocarcinoma
1st investigations to order
- upper GI endoscopy with biopsy
- Barium esophagogram
- autofluorescence imaging
- confocal laser endomicroscopy
- optical coherence tomography
- transnasal endoscopy
- capsule endoscopy
- gelatin-coated sponge
nondysplastic Barrett esophagus
- Esophageal adenocarcinoma
- Guideline on informed consent for GI endoscopic procedures
- Endoscopic eradication therapy for patients with Barrett’s esophagus–associated dysplasia and intramucosal cancer
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