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Barrett'S Esophagus


Norman Barrett discovered this disease in 1957. Barrett's esophagus is a condition caused by inflammation and damage to the lining of the esophagus. Normally, the lower esophagus is lined by squamous epithelium and intestine is lined by columnar epithelium. The lower esophagus when exposed to large amounts of acid leads to a change in the epithelium from the squamous to the columnar epithelium, similar to the intestine and stomach. This change is called metaplasia. This is considered as premalingnant condition as this condition leads to the cancer of esophagus mainly adenocarcinoma. The meta plastic tumour is generally of two types: Gastric, in which the epithelium is similar to that of the stomach. This type  is not considered to be the Barrett's esophagus; while Colonic is the one where the cell is just similar to colon. This type is called Barrett's esophagus. Some cases show both type of metaplasia in biopsy. This is also called as Barrett’s syndrome.

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The main cause of Barrett's esophgus is GERD (gastroesophageal reflux disease). The reflux of acid in the esophagus due to low tone of sphincter or any other cause, leads to a change in the epithelium of the esophagus leading to the either intestines or stomach. The columnar epithelium will bear the exposure to the acid easily, in comparison to the squamous. Amount of exposure to the acid is essential as compared to the severity of exposure. Some researches also shows that there are cases of Barrett's esophagus without any complaints for heartburn i.e excessive exposure to the acid. Barrett's esophagus can also occur from continous exposure to corrosive substances.

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Signs & Symptoms

These include the following:

  • Dysphagia, which causes difficulty in swallowing  
  • Loss of weight, as a manifestation of dysphagia  
  • Pain in the retrosternal area 
  • Blood in vomiting
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Barrett's esophagus cannot be prevented in all cases. To help reduce the risk for developing the condition, patients who have gastroesophageal reflux disease (GERD) should avoid smoking; limit their alcohol consumption; should maintain a healthy weight, exercise regularly, and take all medications recommended by their physician. Patients who experience chronic heartburn should get an upper GI endoscopy done at the age of 40.


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Laser Treatment Modern Medicine

If there is metaplastic change or if there is dysplasia, then LASER treatment is useful to stop the changes. 

Medication to Decrease Acid Content Modern Medicine

Three things are included in the treatment. Firstly, prevention is undertaken, to develop the Barrett's esophagus caused by chronic exposure to the acid. So, first there is endoscopy and then biopsy to look for the changes to the metaplastic tumour. Medication is proton pump inhibitor like omeprazole to decrease the secretion of acid.  
Nissen fundoduplication is an operation to reduce the reflux of the acid. 

Photodynamic Therapy Modern Medicine

Photodynamic Therapy is also used to remove the dysplastic areas around the esophagus.

Radiation Therapy and Chemotherapy Modern Medicine

But if there is esophageal cancer then there is surgery, radiation therapy and chemotherapy 
NSAIDs like aspirin can prevent the esophageal cancer.

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