Barrett Esophagus

Barrett Esophagus

Pathogenesis. Barrett esophagus is a complication of long-standing reflux disease. After sev- eral years of GERD, the epithelium of the lower esophagus undergoes histologic change from a normal squamous epithelium to a columnar  epithelium.

Diagnosis. Patients with Barrett esophagus should have a repeat endoscopy every 2 to 3 years to see whether dysplasia or esophageal cancer has developed. Patients with low-grade dyspla- sia should undergo repeat endoscopy in 3 to 6 months to see if the lesion has progressed or resolved. Patients with high-grade dysplasia should have a distal esophagectomy or an endo- scopic mucosal resection because of its very high rate of progression to invasive esophageal carcinoma. The usual rate of progression to cancer is about 0.5% per year.

Barium studies are typically normal. Endoscopy should be performed if the patient has GERD and if there are alarm symptoms, such as dysphagia, odynophagia, weight loss, anemia, or heme-positive stool. It is not clear when endoscopy should be done when there is a history only of GERD.

Treatment. All patients with Barrett esophagus should receive PPIs.