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Barrett's Esophagus - Coggle Diagram
Barrett's Esophagus
Pathogenesis
Definition
Change in distal esophageal epithelium >1 cm above gastric folds that can be recognized as columnar type mucosa ,and is confirmed to have intestinal metaplasia by biopsy of esophagus
Esophagus that is normally lined by stratified squamous transitions to columnar at squamocolumnar junction
Columnar appearing epithelium with intestinal metaplasia replaces squamous esophagus
Clinical Relevance
Premalignant lesion for adenocarcinoma (associated with lower QoL)
Clinical Presentation
GERD (Heartburn, regurgitation, chest pain, cough, sore throat, water brash, esophagitis, esophageal ulcers, strictures)
Diagnosis and Management
EGD must be performed
Endoscopic evidence of columnar-appearing epithelium, Histological biopsies from area must show specialized intestinal metaplasia
Management
Three main aspects
Screening
Not recommended to screen population with GERD
Screen those with high risk factors (Chronic GERD, >50, male, white race, hiatal hernia, elevated BMI)
Surveillance
Regular monitoring of those with BE to detect progression and complications
Intervention
Pharmacological
PPIs, NSAID drugs
Surgical Antireflux Surgery
Endoscopic/Surgical
Esophagectomy (Gold standard) but less invasive treatments are now availabel
Advanced endoscopic techniques: Perforemd throguh EGD to eliminate dysplasia, Barrett's mucosa, prevent development of esophageal adenocarcinoma.
Endoscopic mucosal resection, Radiofrequency ablation
Esophageal Tumours
Adenocarcinoma
Risk Factors
GERD, Smoking, Obesity
Squamous Cell Carcinoma
Risk Factors
Smoking, Alcohol, Diet low in fruits ang vegetables, pre-existing esophageal disorders
Clinical Manifestations
Age >50, progressive solid food dysphagia, unintentional weight loss, anorexia, retrosternal discomfort, IDA, Advanced (Sialorrhea, hoarseness, aspiration pneumonia, UGI hemorrhage), 40% - History of chronic GERD Symptoms
Diagnosis
Upper endoscopy + Biopsy
Early: Superficial plaques, nodules, ulcerations
Advanced: Strictures, ulcerations, circumferential mass
Radiological studies
Barium Swallow, CT Scan
Staging
Classifying severity/extent of disease, in terms of depth of invasion and spread to lymph nodes and distant sites
Determines prognosis and options for Treatment
Investigations: CT, Endoscopic ultrasound, PET, Endoscopic mucosal resection
Pathology
Adenocarcinoma: 50% of gland formation
Squamous Cell carcinoma - Malignant cells without gland formation
Treatment
Endoscopic Techniques
Stage 0,1,2A
Chemotherapy/Radiation
Mucosal Resection, Submucosal Dissection
Stage 2B, 3
Chemotherapy, Radiation and surgery or Palliation
Palliative
Non-curative, Stage IV, Radiation +/- chemotherapy, Esophageal dilation/stenting, Tumor ablation for debulking (EtOH injection, photodynamic therapy, argon plasma coagulation, cryotherapy), Enteral Feeding
Morphological Feautres
GERD
Spongiosis, Intraepithelial Inflammation, Basal Cell Hyperplasia
Eosinophilic esophagitis
Eosophageal Carcinoma
Barett's
Distal squamous mucosa replaced by columnar epithelium with goblet cells
Dysplasia
Unequivocal neoplastic epithelium confined to basement membrane
Invasion of basement membrane -> Invasive adenocarcinoma
Eosinophilic Esophagitis
Definition
Common cause of dysphagia and heartburn unresponsive to antireflux therapy
Chronic immune/antigen-mediated esophageal disease characterized clincally by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammmation
Pathophysiology
Esophagus normally devoid of eosinophils becomes immunologically active with exposure to stimulus (leads to inflammation, fibrosis, and dysphagia)
Clinical Features
Adults
Dysphagia, Food impaction, Heartburnm caucasian male, allergic history, astham, food allergy
Children
Dysphagia, Vomiting, Abdominal pain, feeding disorder, Food impaction, Rhinoconjuctivitis, Wheezing, Food allergy
Endoscopy
Common Features: Mucosal fragility/edema, linear furrows, ringed esophagus, white pinpoint exudates, strictures
Diagnsois:
Symtpoms related to esophageal dysfuntion, eosinophil-predominant inflammation on esophageal biopsy, mucosal eosinophilia isolated to esophagus and persists after PPI trial, biopsies
Pathology
Intraepithelial Eosinophils
Treatment
Diet: Dietary elimination;restriction
Drugs: Acid suppression and Topical Corticosteroids
Dilation: Esophageal Dilattion
