Barrett's esophagus pathophysiology: Difference between revisions

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* 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]].


* [[Recent]] [[evidence]] [[has]] [[pointed]] [[to]] [[a]] [[similar]] [[condition]] [[developing]] [[in]] [[the]] [[distal]] [[gut]] [[epithelium]].  [[Barrett's]] [[Anus]] [[is]] [[a]] [[metaplastic]] [[change]] [[in]] [[the] [[distal]] [[rectum]] [[whose]] [[cellularity]] [[is]] [[similar]] [[to]] [[that]] [[of]] [[the]] [[gastric]] [[mucosa]]. [[While]] [[the]] [[condition]] [[is]] [[stable]] [[for]] [[many]] [[years]], [[there]] [[has]] [[been]] [[recent]] [[evidence]] [[to]] [[show]] [[that]] [[it]] [[is]] [[the]] [[predisposing]] [[lesion]] [[to]] [[both]] [[anal]] [[teratoma]] [[and]] [[squamous cell carcinoma]] [[of]] [[the]] [[anus]]. [[Frequent]] [[bouts]] [[of]] [[steatorrhea]] [[are]] [[commonly]] [[cited]] [[as]] [[the]] [[most]] [[likely]] [[cause]] [[of]] [[Barrett's Anus]], [[but]] [[much]] [[more]] [[research]] [[needs]] [[to]] [[be]] [[done]] [[in]] [[order]] [[to]] [[rule out]] [[causes]] [[such]] [[as]] [[HPV]] 8,13.
* Recent [[evidence]] has pointed to a similar [[condition]] developing in the [[distal]] [[gut]] [[epithelium]].  [[Barrett's]] [[Anus]] is a metaplastic change in the [[distal]] [[rectum]] whose cellularity is similar to that of the gastric [[mucosa]]. While the [[condition]] is stable for many years, there has been recent [[evidence]] to show that it is the predisposing [[lesion]] to both [[anal]] [[teratoma]] and [[squamous cell carcinoma]] of the [[anus]]. Frequent bouts of [[steatorrhea]] are commonly cited as the most likely cause of [[Barrett's]] [[Anus]], but much more [[research]] needs to be [[done]] in order to rule out [[causes]] such as [[HPV]] 8,13.
* [[It]] [[appears]] [[that]] [[chronic]] [[GE]] [[reflux]] [[is]] [[causes]] [[the]] [[injury]] – [[repair]] [[cycle]] [[that]] [[stimulates]] [[squamous]] [[metaplasia]]. [[The]] [[columnar cells]] [[are]] [[more]] [[resistant]] [[to]] [[acid]] [[injury]] [[than]] [[the]] [[squamous cells]].
* [[It]] [[appears]] [[that]] [[chronic]] [[GE]] [[reflux]] [[is]] [[causes]] [[the]] [[injury]] – [[repair]] [[cycle]] [[that]] [[stimulates]] [[squamous]] [[metaplasia]]. [[The]] [[columnar cells]] [[are]] [[more]] [[resistant]] [[to]] [[acid]] [[injury]] [[than]] [[the]] [[squamous cells]].
*:* [[Patients]] [[with]] BE [[tend]] [[to]] [[have]] [[more]] [[severe]] [[GERD]].
*:* [[Patients]] with BE tend to have more severe [[GERD]].
* [[Although]] [[one]] [[would]] [[think]] [[that]] BE [[develops]] [[over]] [[years]], [[with]] [[slow]] [[replacement]] [[of]] [[squamous cells]] [[by]] [[columnar cells]], [[it]] [[appears]] [[that]] [[this]] [[is]] [[not]] [[the]] [[case]]. BE [[tends]] [[to]] [[develop]] [[all]] [[at]] [[once]] [[with]] [[little]] [[or]] [[no]] [[progression]]. [[The]] [[reason]] [[for]] [[this]] [[is]] [[unknown]].
* Although one would think that BE develops over years, with [[slow]] replacement of [[squamous]] [[cells]] by [[columnar]] [[cells]], it appears that this is not the case. BE tends to develop all at once with little or no progression. The reason for this is unknown.
* Paull et.al. [[described]] [[three]] [[types]] [[of]] [[columnar epithelium]] [[that]] [[can]] [[be]] [[seen]] [[in]] BE:
* Paull et.al. described three types of [[columnar epithelium]] that can be seen in BE:
*:* [[Gastric]] [[junctional]]-[[type]] [[epithelium]] [[which]] [[has]] [[a]] [[pitted]] ([[foveolar]]) [[surface]] [[and]] [[mucus-secreting cells]].
*:* [[Gastric]] junctional-type [[epithelium]] which has a pitted (foveolar) surface and mucus-secreting cells.
*:* [[Gastric]] fundus-type [[epithelium]] [[that]] [[also]] [[has]] [[a]] [[pitted]] [[surface]] [[lined]] [[by] [[mucus-secreting cells]], [[in]] [[addition]] [[to]] [[having]] [[a]] [[deeper]] [[glandular]] [[layer]] [[that]] [[contains]] [[chief]] [[and]] [[parietal cells]].
*:* [[Gastric]] fundus-type [[epithelium]] that also has a pitted surface lined by mucus-secreting cells, in addition to having a deeper [[glandular]] layer that contains [[chief]] and [[parietal cells]].
*:* [[Specialized]] [[intestinal]] ([[columnar]]) [[metaplasia]] [[that]] [[has]] [[a]] [[villiform]] [[surface]] [[with]] [[mucus]] [[secreting]] [[columnar cells]] [[and]] [[goblet cells]].
*:* Specialized [[intestinal]] (columnar) [[metaplasia]] that has a villiform surface with [[mucus]] secreting [[columnar]] [[cells]] and [[goblet cells]].


==Microscopic Pathology==
==Microscopic Pathology==

Revision as of 16:01, 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]

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  • 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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