What is Barrett's Esophagus?

The squamous epithelium in the lower part of the esophagus is covered by columnar epithelium. Because Barrett of the British first reported it, it is called Barrett's esophagus, and the Chinese translation is Barrett's esophagus. At present, it is considered to be acquired, which may be related to reflux esophagitis, and there is a possibility of adenocarcinoma. The symptoms are mainly caused by gastroesophageal reflux and complications. The symptoms of gastroesophageal reflux are post-sternal burning, chest pain and nausea.

Basic Information

nickname: Barrett's esophagus
English alias: Barrettesophagus

Visiting department: Gastroenterology
Multiple groups: Middle-aged and elderly men
Common symptoms: Burning sternum, chest pain, nausea

Causes of Barrett's esophagus

The cause of Barrett's esophagus is not fully understood. Although the relationship between Barrett's esophagus and gastroesophageal reflux has been accepted by most scholars, the exact pathogenesis of Barrett's esophagus remains unclear. This is because only 10% of patients with gastroesophageal reflux disease develop Barrett's esophagus, while 90% of patients do not change. There have been two kinds of theories for a long time, namely the congenital theory and the acquired theory.

Congenital doctrine

The congenital theory holds that Barrett's esophagus is caused by the fact that the columnar epithelium was not completely replaced by squamous epithelium during human embryonic development, so the embryonic columnar epithelium was left in the lower esophagus. Some clinical observations also support the congenital doctrine.

2. The doctrine of acquisition

Studies have suggested that Barrett's esophagus is an acquired disease, which is closely related to gastroesophageal reflux disease. Long-term exposure of the lower esophagus to acidic solutions, gastric enzymes, and bile causes inflammation and destruction of the esophageal mucosa, causing acid-resistant columnar epithelium to replace squamous epithelium. Studies have confirmed that most patients with Barrett's esophagus have reflux esophagitis.

The origin of Barrett's esophageal columnar epithelium has not been determined. There are currently several views: derived from squamous epithelial basal cells; derived from esophageal and gastric cardia gland cells; derived from gastric mucosa or primordial stem cells.

Barrett's esophagus clinical manifestations

The onset age of Barrett's esophagus has been reported from 1 month to 88 years of age. The age distribution curve shows double peaks, the first peak is 0 to 15 years old, and the other peak is 48 to 80 years old, but it is more common in middle and old ages. people. Barrett's esophagus is more common in men. Patients only have columnar epithelial metaplasia at the lower end of the esophagus, which is generally asymptomatic, so most patients can remain asymptomatic for life. Barrett's esophagus symptoms are mainly caused by gastroesophageal reflux and complications. Typical gastroesophageal reflux symptoms are post-sternal burning (commonly known as heartburn), chest pain, and nausea or acid reflux. Some patients swallow due to esophageal stricture or cancer. difficult. A few patients are asymptomatic, but only stumbled upon gastroscopy.

Barrett's esophagus

1. X-ray examination

It is more difficult to find Barrett's esophagus, which has esophageal hiatal hernias and reflux esophagitis, and is not specific to this disease. Barrett's esophagus should be suspected if peptic stenosis or ulcers are found on the esophagus.

2. Esophagoscopy

The typical Barrett's esophagus is a red columnar epithelial area above the junction of the gastroesophagus. Some patients can see signs of reflux esophageal injury. Biopsy can confirm and find columnar epithelial metaplasia.

3. Esophageal manometry and pH monitoring

In Barrett's esophagus, the pressure of the gastroesophageal reflux can be seen when the esophagus is in contact with acid and alkali reflux for a long time.

Barrett's esophagus diagnosis

The clinical diagnosis of Barrett's esophagus is endoscopic and biopsy.

Barrett's esophageal differential diagnosis

Barrett's esophagus is sometimes distinguished from early esophageal or cardiac cancer.

Barrett's esophageal complications

Barrett's esophageal complications include reflux esophagitis, esophageal stricture, ulcers, perforation, bleeding, and aspiration pneumonia.

Barrett's esophagus treatment

Drug treatment

(1) Proton pump inhibitors (PPIs) are the drugs of choice for medical treatment, and the dosage should be large, such as omeprazole, pantoprazole, rabeprazole, esomeprazole, and so on. After the symptoms are controlled, the treatment is maintained in small doses. There is evidence that PPIs can shorten the length of Barrett's mucosa after long-term treatment. In some cases, the BE mucosa is covered with squamous epithelium, suggesting that PPIs can partially reverse BE, but it is difficult to achieve complete reversal. PPIs treatment can also make BE midgut metaplasia and dysplasia subsided, indicating that PPIs can prevent the development of BE disease, increase the chance of squamous epithelium reversion, and reduce the risk of malignant transformation.

(2) Prokinetic drugs (domperidone, etopril, etc.) These drugs can reduce gastroesophageal reflux and control symptoms, but the course of treatment is longer. For example, domperidone and etopril are often used together with PPIs to increase the efficacy.

(3) Other mucosal protective agents also have certain effects, which can improve symptoms and have better effects when combined with PPIs.

2. Endoscopic treatment

With the development of endoscopic treatment technology, endoscopic ablation treatments (EATs) have been used in clinical practice in recent years. EATs can be divided into three categories: thermal ablation, chemical ablation, and mechanical ablation. Thermal ablation includes multipolar electrocoagulation (MPEC), argon photocoagulation (APC), and lasers (KTP, YAG, etc.). Chemical ablation mainly refers to photodynamic therapy (PDT). The basic principle is to first inject intravenously a photosensitizer such as hemocyanin to localize the metaplasia or dysplasia of the esophagus or adenocarcinoma. Causes local tissue necrosis. Mechanical ablation uses extraction and resection under endoscope. EATs plus PPIs acid suppression therapy is currently an effective method for the treatment of BE and BE with dysplasia, which can make BE epithelium disappear or reverse to squamous epithelium with a curative effect of 70% to 100% and a low incidence of complications. However, the use of EATs is not long, the number of cases is small, and the follow-up time is short. Its efficacy needs time to test, and whether the incidence of adenocarcinoma can be reduced after reversal of metaplastic epithelium remains to be further evaluated. Patients with obvious esophageal stenosis can perform esophageal probing or balloon dilation, but the effect is relatively short and may require multiple expansions.

3. Surgical treatment

The indications for surgery are:

(1) BE with severe symptomatic reflux, ineffective medical treatment.

(2) Patients with esophageal stenosis who fail to undergo dilation.

(3) Refractory ulcers.

(4) Those with severe dysplasia or cancer.

Barrett esophagus prevention

Changing your lifestyle is the best way to prevent heartburn. Try to eat less high-fat meals, chocolate, coffee, candy, sweet potatoes, potatoes, and taro; strictly quit smoking and stop drinking; eat fewer meals, and you should not lie down immediately after a meal. It is best not to eat 2 to 3 hours before bedtime; if it is easy to acid reflux at night, it is best to raise the bedside 10 to 20 cm during sleep; in addition, psychological factors are also very important, such as anxiety and depression will make the digestive system poor Responsive, so stress relief is equally important during stressful times.