Male Patient with Chronic GERD

Thursday, March 25, 2010
This is the Upper GI Endoscopy of 61 years old male ,showing the lower part of the Oesophagus  who has been suffering from heartburn and reflux of stomach acid into the mouth for several years.

What is the Diagnosis?
How would you confirm it?


ANSWER

Barrett's esophagus or Barrett's syndrome due to Chronic GERD.
Barrett's oesophagus is a condition in which there is gastric or intestinal metaplasia of the mucosa of the distal oesophagus thought to be caused by damage from chronic acid exposure, or reflux esophagitis


It is considered to be a premalignant condition because it is associated with an increased risk of esophageal cancer (more specifically, adenocarcinoma)


Barrett's oesophagus is most common in elderly adults

CLINICAL FEATURES

There is a relationship between chronic heartburn and the development of Barrett's esophagus
Sometimes people with Barrett's esophagus will have no heartburn symptoms at all.
Barrett's esophagus does not cause any particular symptoms.But WARNING SIGNS are
Dyspepsia
Dysphagia
Vomiting
Haemetemesis
Melaena
Retrosternal pain that radiates to the neck

DIAGNOSIS

Barrett's oesophagus is defined as columnar metaplasia of the oesophageal mucosa which ranges more than 2 cm from the gastro-oesophageal junction.
Endoscopic visualisation and biopsy are diagnostic.
Colonic metaplasia is usually identified by finding goblet cells in the epithelium
For the defenitive identification of globlet cells
Histochemical stain Alcian blue pH 2.5
Immunohistochemical analysis with antibodies to CDX-2 can be used

TREATMENT

In pre malignant stage
Regular endoscopy monitoring and biopsy
If two endoscopies and biopsy sessions performed within 12 months are negative for dysplasia then surveillance can be performed every 3 years
Intensive anti-reflux measures (long term proton pump inhibitor therapy)


High grade dysplasia - laser ablation of the site of metaplasia


Malignancy may require surgery, radiation therapy, or systemic chemotherapy

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14 comments

  1. Appears to be Barett's Esophagus i.e metaplasia of squamous esophageal epithelium into intestinal type of columnar epithelium at the lower end of esophagus usually more than 3 cm proximally from GE junction. Biopsy with HPE is solicited.

     
  2. hadi Says:
  3. Barett's esophagus

    confirmed by UGI endoscopy + biopsy

     
  4. Anonymous Says:
  5. Barret Oesophagus
    Confirmation by Upper GIT endoscopy+biopsy

     
  6. Waseem Says:
  7. Barret's esophagous
    confirm by a Biopsy

     
  8. Anonymous Says:
  9. arash from iran

    barret esophagus

    biopsy

     
  10. this is Barret's oesophagus..
    can be confirmed by upper GI endoscopy followed by biopsy of the lesion..

     
  11. Anonymous Says:
  12. Barret's esophagus. Confirm with biopsy. metaplasia

     
  13. Anonymous Says:
  14. barret's esophagus.confirm by endoscopy and biopsy

     
  15. Lee JW Says:
  16. Barret's esophagus.
    conformed by endoscopic finding and histologic fing.

    Spechler SJ. Barrett's esophagus. N Engl J Med 2002; 346:836.

     
  17. Bobbymurjani Says:
  18. i dont know... its like an erosion .. it can be malignant or just chronic state of infection... i need a biopsi to looking for a metaplastic cell

     
  19. Anonymous Says:
  20. simran
    barret esophagus ....... the complaints and the chronicity of the proceess with the endoscopy confirms the dignosis it is the only proceess of the esopagus that can lead to adeno carcinoma

     
  21. The given description suggests Gastro Oesophagial Reflux Diseas [GORD]
    It can cofirmed by Endoscopy & a pH monitering.
    But there's some mucosal changes that can be seen in above image, suggests Barret's oesophagus.
    It a pre-malignant glandular metaplasia of lower oesophagus, that normal squamous lining is replaced by columnar mucosa.
    Endoscopy shows pinkish columnar mucosa.

     
  22. Anonymous Says:
  23. this pic not very clear...if it's in colour,it would b easier to diagnosed...huhu...barret esophagus,we can see reddish mucosal patches intervene with other pale pink mucosa

     
  24. Medical diagnosis on acid reflux or heartburn may have caused by regular smoking, drinking alcohol and stress. But changing the kind of lifestyle and diet that you practice can control lessen the pain. It's better to take natural medications to improve one's health condition.

     

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