Barrett's esophagus pathophysiology: Difference between revisions

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* There are [[many]] [[histological]] [[mimics]] of [[Barrett's esophagus]] (i.e. [[goblet cells]] occurring in the [[transitional epithelium]] of [[normal]] [[esophageal]] [[submucosal]] gland ducts, "pseudogoblet cells" in which abundant foveolar (gastric) type [[mucin]] simulates the [[acid]] [[mucin]] true [[goblet cells]]).  Assessment of relationship to [[submucosal glands]] and [[transitional-type epithelium]] with [[examination]] of multiple levels through the [[tissue]] may allow the [[pathologist]] to reliably distinguish between [[goblet cells]] of [[submucosal gland ducts]] and true [[Barrett's esophagus]] (specialized columnar [[metaplasia]]).  Use of the histochemical [[stain]] Alcian [[blue]] (with [[pH]]=2.5) is also frequently used to distinguish true intestinal-type [[mucin]] from their [[histological]] [[mimics]]. Recently, [[immunohistochemical]] [[analysis]] with [[antibodies]] to CDX-2 (specific for mid and [[hind-gut]] [[intestinal]] derivation) has also been utilized to identify true intestinal-type metaplastic cells.  
* There are [[many]] [[histological]] [[mimics]] of [[Barrett's esophagus]] (i.e. [[goblet cells]] occurring in the [[transitional epithelium]] of [[normal]] [[esophageal]] [[submucosal]] gland ducts, "pseudogoblet cells" in which abundant foveolar (gastric) type [[mucin]] simulates the [[acid]] [[mucin]] true [[goblet cells]]).  Assessment of relationship to [[submucosal glands]] and [[transitional-type epithelium]] with [[examination]] of multiple levels through the [[tissue]] may allow the [[pathologist]] to reliably distinguish between [[goblet cells]] of [[submucosal gland ducts]] and true [[Barrett's esophagus]] (specialized columnar [[metaplasia]]).  Use of the histochemical [[stain]] Alcian [[blue]] (with [[pH]]=2.5) is also frequently used to distinguish true intestinal-type [[mucin]] from their [[histological]] [[mimics]]. Recently, [[immunohistochemical]] [[analysis]] with [[antibodies]] to CDX-2 (specific for mid and [[hind-gut]] [[intestinal]] derivation) has also been utilized to identify true intestinal-type metaplastic cells.  


* [[In]] [[the]] [[United States]], [[it]] [[is]] [[estimated]] [[that]] 8 - 12% [[of]] [[patients]] [[who]] [[are]] [[diagnosed]] [[with]] [[Barrett's esophagus]] [[have]] [[been]] [[misdiagnosed]]. [[This]] [[significant]] [[diagnostic]] [[error]] [[may]] [[result]] [[in]] [[higher]] [[rates]] [[of]] [[medical]] [[and]] [[life]] [[insurance]] [[rates]] [[for]] [[those]] [[misdiagnosed]]; [[as well as]] [[enrollment]] [[of]] [[patients]] [[in]] [[unnecessary]] [[surveillance]] [[programs]] (i.e. [[annual]] [[endoscopic]] [[evaluation]] [[and]] [[biopsy]] [[to]] [[monitor]] [[for]] [[the]] [[development] [[of]] [[Barrett's esophagus]]). [[Second]] ([[consulting]]) [[opinions]] [[on]] [[pathologic]] [[materials]] [[are]] [[easily]] [[available]] [[as]] [[slides]] [[and]] [[tissue blocks]] [[are]] [[retained]] [[for] 10 and 20 [[years]], [[respectively]]. [[To]] [[request]] [[a]] [[consultation]] [[opinion]], [[patients]] [[may]] [[contact]] [[their]] [[gastroenterologist]] [[for]] [[referral]] [[to]] [[a]] [[GI]] [[pathology]] [[specialty]] [[center]].
* In the [[United States]], it is estimated that 8 - 12% of [[patients]] who are [[diagnosed]] with [[Barrett's esophagus]] have been misdiagnosed. This significant [[diagnostic]] [[error]] may [[result]] in higher [[rates]] of [[medical]] and [[life]] [[insurance]] [[rates]] for those [[misdiagnosed]]; as well as enrollment of [[patients]] in unnecessary surveillance programs (i.e. annual [[endoscopic]] evaluation and [[biopsy]] to monitor for the development of [[Barrett's esophagus]]). [[Second]] (consulting) opinions on [[pathologic]] [[materials]] [[are]] [[easily]] [[available]] [[as]] [[slides]] [[and]] [[tissue blocks]] [[are]] [[retained]] [[for] 10 and 20 [[years]], [[respectively]]. [[To]] [[request]] [[a]] [[consultation]] [[opinion]], [[patients]] [[may]] [[contact]] [[their]] [[gastroenterologist]] [[for]] [[referral]] [[to]] [[a]] [[GI]] [[pathology]] [[specialty]] [[center]].


* [[After]] [[the]] [[initial]] [[diagnosis]] [[of]] [[Barrett's esophagus]] [[is]] [[rendered]], [[affected]] [[persons]] [[undergo]] [[annual]] [[surveillance]] [[to]] [[detect]] [[changes]] [[that]] [[indicate]] [[higher]] [[risk]] [[to]] [[progression]] [[to]] [[cancer]]: [[development]] [[of]] [[dysplasia]]. [[There]] [[is]] [[considerable]] [[variability]] [[in]] [[assessment]] [[for]] [[dysplasia]] [[among]] [[pathologists]].  [[Recently]], [[gastroenterology]] and [[GI]] [[pathology]] [[societies]] [[have]] [[recommended]] [[that]] [[any]] [[diagnosis]] [[of]] [[high]] [[grade]] [[dysplasia]] [[in]] [[Barrett's]] [[be]] [[confirmed]] [[by]] [[at]] [[least]] [[two]] [[fellowship]] [[trained]] [[GI]] [[pathologists]] [[prior]] [[to]] [[definitive]] [[treatment]] [[for]] [[patients]].
* [[After]] [[the]] [[initial]] [[diagnosis]] [[of]] [[Barrett's esophagus]] [[is]] [[rendered]], [[affected]] [[persons]] [[undergo]] [[annual]] [[surveillance]] [[to]] [[detect]] [[changes]] [[that]] [[indicate]] [[higher]] [[risk]] [[to]] [[progression]] [[to]] [[cancer]]: [[development]] [[of]] [[dysplasia]]. [[There]] [[is]] [[considerable]] [[variability]] [[in]] [[assessment]] [[for]] [[dysplasia]] [[among]] [[pathologists]].  [[Recently]], [[gastroenterology]] and [[GI]] [[pathology]] [[societies]] [[have]] [[recommended]] [[that]] [[any]] [[diagnosis]] [[of]] [[high]] [[grade]] [[dysplasia]] [[in]] [[Barrett's]] [[be]] [[confirmed]] [[by]] [[at]] [[least]] [[two]] [[fellowship]] [[trained]] [[GI]] [[pathologists]] [[prior]] [[to]] [[definitive]] [[treatment]] [[for]] [[patients]].

Revision as of 14:45, 22 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amresh Kumar MD [2]

Pathophysiology

Microscopic Pathology

  • On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

References

  1. Fléjou J (2005). "Barrett's oesophagus: from metaplasia to dysplasia and cancer". Gut. 54 Suppl 1: i6–12. PMID 15711008.

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