Barrett's esophagus

Barrett's esophagus The squamous epithelium of the lower esophagus is covered by a columnar epithelium, called the Barrett's esophagus, also known as the Barrett's esophagus. It is generally considered to be acquired and associated with reflux esophagitis, and there is a possibility of adenocarcinoma. The ectopic columnar epithelium remains in the esophagus and can occur anywhere in the esophagus. The symptoms are mainly caused by gastroesophageal reflux and complications. Gastroesophageal reflux symptoms are post-sternal burning, chest pain and nausea. basic knowledge Sickness ratio: 0.0001% Susceptible people: no specific population Mode of infection: non-infectious Complications: reflux esophagitis aspiration pneumonia

Barrett's esophagus

Congenital factors (55%):

From the perspective of embryology, when the human embryo develops to 3 to 34 mm (4 months ago), the original foregut (precursor of the esophagus) is covered with a columnar epithelium, which develops to 130-160 mm (18 to 20 weeks), scaly The epithelium begins to replace the columnar epithelium. This change begins in the center of the esophagus and gradually develops toward the stomach and mouth. It is completed before birth. If this extension is blocked, it may cause the lower esophagus to be covered with columnar epithelium after birth. And residual columnar epithelial cells in the upper part of the esophagus. Barrett's esophagus is caused by the fact that the columnar epithelium is not completely replaced by the squamous epithelium during human embryonic development. An autopsy confirmed that a columnar epithelium was found in the esophagus of a stillborn baby.

Gastroesophageal lesions (25%):

At present, more and more animal experiments and clinical research evidence show that Barrett's esophagus is closely related to gastroesophageal reflux disease. The lower esophagus is exposed to acidic solution, gastric enzyme and bile, causing inflammation and destruction of esophageal mucosa. The acid-resistant columnar epithelium replaces the squamous epithelium. Studies have confirmed that most patients with Barrett's esophagus have reflux esophagitis. Clinically, some surgical procedures, such as esophageal myotomy, total gastrectomy plus esophageal jejunostomy Barrett's esophagus can occur after surgery such as gastroesophageal lateral anastomosis. The mechanism is mainly due to the destruction of the integrity of the lower esophageal sphincter, which causes gastric acid and bile reflux or esophageal and gastric emptying. In addition, chemotherapy has also been reported. The drug can damage the esophageal mucosa and cause Barrett's esophagus.

Pathogenesis

Regarding the origin of the Barrett's esophageal columnar epithelium, there are several conclusions:

1 basal cells derived from squamous epithelium.

2 from the esophageal cardia gland cells.

3 from the gastric mucosa or primitive stem cells.

The main pathological feature of BE is that the columnar epithelium extends from the stomach upward to the lower third part of the esophagus, mostly within 6 cm of the lower esophagus, while the submucosal and muscular layers are normal, and the columnar epithelium has three histological types:

1. The fundus gland is similar to the gastric fundus epithelium, which contains pits and mucous glands. It has primary cells and parietal cells that secrete gastric acid and pepsinogen, but these glands are rare and short compared to normal mucosa.

2. Gastric cardia junction type is characterized by the cardia gland of the cardia. The surface has pits and villi. The surface of the pit and gland is covered by cells secreting mucus, which lacks the main cells and parietal cells.

3. The special columnar epithelium is similar to the small intestine epithelium, with villi and lacuna on the surface. It consists of columnar cells and goblet cells. The columnar cells are different from the normal small intestines. There is no clear brush border, and the cytoplasm contains glycoprotein secretion. Granules, which do not have a fat-absorbing function, are equivalent to incomplete intestinal metaplasia, which is the most common type.

Barrett's esophagus can form ulcers, known as Barrett's ulcers. It is considered to be a precancerous lesion of esophageal adenocarcinoma. BE ulcers are deeper, so it is easy to perforate. For example, ulcers penetrate the esophageal wall, and may be complicated by pleural and mediastinal suppurative infection or mediastinal tissue. Fibrosis and peripheral lymphadenitis.

Barrett's esophagus prevention

Lifestyle change is the best way to prevent pantothenic heartburn. Try to eat high-fat meal chocolate coffee candy sweet potato potato taro as much as possible; strictly quit smoking and stop drinking.

After eating less meals, it is not advisable to lie down immediately before going to bed. 2---3 hours, it is best not to eat.

If it is easy to acidify at night, it is best to raise the bedside by 10-20 cm during sleep. In addition, we believe that psychological factors are also very important. The psychological factors have a great influence on the digestive system, such as anxiety and depression. Let the digestive system have an adverse reaction, so it is equally important to pay attention to stress relief during stress.

Barrett's esophagus complications Complications, reflux esophagitis, aspiration pneumonia

Serious complications can occur in Barrett's esophagus. Benign complications include reflux esophagitis, esophageal stricture, ulceration, perforation, hemorrhage and aspiration pneumonia. The incidence of Barrett's esophageal complications is shown in Table 3.

Common complications are:

1. Ulcer: The incidence of ulcer caused by Barrett's esophagus is 2% to 54%. The esophageal columnar epithelium can be ulcerated after being corroded by acidic digestive juice. Symptoms similar to gastric ulcer can occur. The pain can be radiated to the back and can cause perforation and bleeding. Infiltration, stenosis after ulcer healing, symptoms of poor pharyngeal sphincter, and even death due to massive bleeding through the aorta. There are two pathological types of Barrett ulcer, the most common one occurring in the squamous epithelium. Superficial ulcers, this type is similar to ulcers caused by reflux esophagitis, and another rare form is a deep ulcer that occurs in the columnar epithelium, similar to peptic ulcer.

2. Stenosis: Esophageal stricture is the most common complication of Barrett's esophagus, the incidence is 15% to 100%, the stenosis is more than the squamous-columnar epithelial junction in the upper and middle esophagus, and the stenosis caused by gastroesophageal reflux is mostly located in the esophagus. In the lower segment, the incidence of reflux esophagitis is 29% to 82%. The lesion may involve the columnar epithelium alone or both the squamous and columnar epithelium.

3. malignant transformation: the incidence of cancer in Barrett's esophagus is not very accurate, long-term reflux into the Barrett's esophagus may play a malignant effect, but studies have concluded that patients with Barrett's esophagus with anti-reflux surgery can not make these columnar epithelium subsided Does not reduce the risk of malignant transformation, phenotypic hyperplasia can occur in the columnar epithelial area of Barrett's esophagus, the degree can be from low to high, sometimes low dysplasia is not easy to distinguish from normal columnar epithelium, high dysplasia and cancer in situ sometimes difficult Differentiate and can progress to invasive cancer. These malignant tumors are adenocarcinomas. It should be noted that endoscopic findings of gastric cardia adenocarcinoma with benign columnar epithelium and columnar epithelial dysplasia are different. Adenocarcinoma of Barrett's esophagus is different. Hyperplasia is a precancerous condition that has been recognized by most people.

4. Gastrointestinal bleeding: It can be manifested as hematemesis or blood in the stool, accompanied by iron deficiency anemia, the incidence rate is about 45%, and the source of bleeding is esophagitis and esophageal ulcer.

Barrett's esophageal symptoms Common symptoms Blood in the stool, sternal pain, swallowing, heartburn, nausea and vomiting

Barrett's esophagus does not produce symptoms itself. The patient's symptoms are mainly caused by reflux esophagitis and its accompanying lesions. The most common symptoms are acid reflux, heartburn, followed by retrosternal pain and upper abdominal pain. When esophageal stricture occurs, The prominent symptom is difficulty in swallowing, and the reasons for difficulty in swallowing are:

a stenosis at the junction of the scale-columnar epithelium;

2 chronic esophagitis caused by wall fibrosis, esophageal peristalsis decreased;

3 esophageal fistula caused by acute inflammation of the esophagus;

4 luminal obstruction caused by esophageal adenocarcinoma of the columnar epithelium, some patients have heartburn symptoms in the early stage, after a long period of asymptomatic period, until symptoms appear after the complications, because the columnar epithelium is not as good as the stimulation of the digestive juice Squamous epithelium is sensitive, Barrett's esophageal hemorrhage can be large, but often chronic an iron deficiency anemia, a small number of perforation or invasion of the pleural cavity caused by fistula or other adjacent organs.

Barrett's esophagus inspection

Esophageal motility detection of patients with BE under the esophageal sphincter dysfunction, lower esophageal pressure, easy to form gastroesophageal reflux, and the ability to clear the reflux acid, so by monitoring the patient's esophageal pressure and pH, prompt BE The existence of certain reference has a certain reference significance. It is generally considered that the lower esophageal sphincter pressure is less than 1.33 kPa for dysfunction. Ranson et al. determined that the normal human esophageal sphincter pressure was 2.6 kPa ± 7 kPa, while in patients with extensive BE it was 0.97 kPa ± 3.46 kPa. , significantly lower than the normal control group, when the endoscope can not determine the lower esophageal boundary, biopsy can also be carried out under the guidance of pressure measurement.

1. X-ray examination: it is difficult to find Barrett's esophagus, there is the performance of esophageal hiatal hernia and reflux esophagitis, not the specificity of this disease, it is suspected that there is Barrett's esophagus in patients with digestive stenosis or ulceration of the body.

2. Endoscopy: It is easier to confirm Barrett's mucosa under endoscopy. The normal esophageal mucosa is pinkish gray, while the columnar epithelium is orange-red in the gastric mucosa. There are significant differences between the two. Endoscopic BE can be divided into three types:

(1) Whole-circle type: the red mucosa extends to the esophagus and affects the whole week, and has no obvious boundary with the gastric mucosa. The free margin is more than 3 cm from the lower esophageal sphincter.

(2) Island type: patchy red mucosa appeared above 1 cm of the dentate line.

(3) Tongue type: connected to the dentate line, extending to the esophagus in the form of a peninsula. In the Barrett epithelium, congestion, edema, erosion or ulceration may occur, and ulcers that repeatedly heal may cause esophageal stenosis.

3. Esophageal manometry and pH monitoring In patients with Barrett's esophagus, the contact time of acid and alkali reflux is long, and the pressure of gastroesophageal reflux is seen. The lower esophageal sphincter pressure is lower than that of general reflux patients.

Barrett's esophagus diagnosis

The clinical diagnosis of Barrett's esophagus should be based on the patient's medical history, clinical manifestations, esophageal manometry, pH monitoring, endoscopy and biopsy. The most diagnostic method is endoscopy and biopsy.

Barrett's esophagus sometimes needs to be differentiated from early ulcerated gastric cancer. Gastric cancer ranks first among all kinds of malignant tumors in China, and there are obvious regional differences in the incidence of gastric cancer. The incidence of gastric cancer in the northwest and eastern coastal areas of China is significantly higher than that in the southern regions.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.