Barrett s esophagus

O GERD can be divided into three distinct categories erosive esophagitis, non-erosive reflux disease, and Barrett s esophagus. 

These symptoms may be indicative of complications of GERD such as Barrett s esophagus, esophageal strictures, or esophageal cancer. 

More specific diagnostic tests may be warranted in patients not responding to empiric (prescription) therapy, those with complicated or alarm symptoms (e.g., weight loss or dysphagia), or those with long-standing symptoms who are at risk for Barrett s esophagus. 

Upper gastrointestinal endoscopy is the preferred diagnostic test for assessing the mucosa for esophagitis and Barrett s esophagus.1 It enables visualization and biopsy of the esophageal mucosa. Endoscopy should be considered upon initial presentation in any patient who presents with complicated symptoms and those at risk for Barrett s esophagus.1... 

The PPIs are superior to H2RAs in patients with moderate to severe GERD. This includes not only patients with erosive esophagitis or complicated symptoms (Barrett s esophagus or strictures), but also those with non-erosive reflux disease who have moderate to severe symptoms. Symptomatic relief is seen in approximately 83% of patients and healing rates at 8 weeks as judged by endoscopy are 78%.1... 

Many patients with GERD relapse if medication is withdrawn, and long-term maintenance treatment is required in such patients.1 Candidates for maintenance therapy include patients whose symptoms return once therapy is discontinued or decreased, patients with complications such as Barrett s esophagus or strictures, and perhaps patients with atypical symptoms. 

Most infants have physiologic reflux with no clinical consequence.26 Complications, although rare, include distal esophagitis, failure to thrive, esophageal strictures, and Barrett s esophagus.27... 

FIGURE 15.4 Computer record of a two-dimensional capillary electrophoresis analysis of a protein homogenate prepared from ahiopsy obtained from the fundus of a Barrett s esophagus patient. The data were generated hy performing 1 s transfers between capillaries and a 9 s second-dimension separation. The first-dimension separation employed the same buffer as the CSE separation in Fig. 15.1 and the second-dimension separation employed the same buffer as the MECC separation in Fig. 15.1. 

This sample is a biopsy taken from the fundus of a patient with Barrett s esophagus under informed consent. The biopsy was fixed in 70% ethanol within 15 s of sampling and was homogenized within 5 min. It is possible to obtain the sample, process it, and complete the electrophoresis within 1 h. The biopsy is roughly 3 mm long, 1 mm wide and 500 pm deep. Its total protein content is 150 pg. This homogenate is prepared in 400 pL of solution and can be used for dozens of analyses. 

Barium radiography is less expensive than endoscopy but lacks the sensitivity and specificity needed to accurately determine the presence of mucosal injury or to distinguish Barrett s esophagus from esophagitis. Twenty-four-hour ambulatory pH monitoring is useful in patients who continue to have symptoms without evidence of esophageal damage, patients who are refractory to standard treatment, and patients who... 

Esophagus (biopsies from human Barrett s esophagus metaplastic tissue)... 

A number of observations (Table 3.6) indicate that tumours arise in an apoptosis-resistant pre-malignant cell population. Barrett s esophagus (BE) is a pre-malignant lesion of the distal esophagus in which squamous epithelial cells... 

P. C. Konturek, A. Nikiforuk, J. Kania, M. Raithel, E. G. Hahn and S. Muhldorfer, Activation of NFkappaB represents the central event in the neoplastic progression associated with Barrett s esophagus a possible link to the inflammation and over-expression of COX-2, PPARgamma and growth factors. Dig. Dis. Sci., 2004, 49(7-8), 1075. 

K. Dvorakova, C. M. Payne, L. Ramsey, H. Bernstein, H. Holubec, M. Chavarria, C. Bernstein, R. E. Sampliner, C. Riley, A. Prasad and H. Garewal, Apoptosis resistance in Barrett s esophagus ex vivo bioassay of live stressed tissues. Am. J. Gastroenterol, 2005, 100(2), 424. 

J. Dominguez, B. Dvorak, H. Bernstein, C. Bernstein, A. Prasad, R. Pass, H. Cui and H. Garewal, Increased expression and secretion of interleukin-6 in patients with Barrett s esophagus, Clin. Cancer Res., 2004,10(6), 2020. 

M. Menges, M. Muller and M. Zeitz, Increased acid and bile reflux in Barrett s esophagus compared to reflux esophagitis, and effect of proton pump inhibitor therapy. Am. J. Gastroenterol., 2001, 96(2), 331. 

H. J. Stein, W. K. Kauer, H. Feussner and J. R. Siewert, Bile reflux in benign and malignant Barrett s esophagus effect of medical acid suppression and nissen fundoplication, J. Gastrointest. Surg., 1998, 2(4), 333. 

Type I tumor Adenocarcinoma of the distal esophagus, which usually arises from an area with specialized intestinal metaplasia of the esophagus (i.e., Barrett s esophagus) and which may infiltrate the esophagogastric junction from above. 

Wilson KT, Fu S, Ramanujam KS, et al. Increased expression of inducible nitric oxide synthase and cyclooxygenase-2 in Barrett s esophagus and associated adenocarcinomas. Cancer Res 1998 58 2929-2934. 

Proton pump inhibitors are the most effective agents for the treatment of nonerosive and erosive reflux disease, esophageal complications of reflux disease (peptic stricture or Barrett s esophagus), and extraesophageal manifestations of reflux disease. Once-daily dosing provides effective symptom relief and tissue healing in 85-90% of patients up to 15% of patients require twice-daily dosing. 

Bian, Y.-S., Osterheld, M.-C., Bosman, F. T., Benhattar, J., and Fontolliet, C. 2001. p53 gene mutation and protein accumulation during neoplastic progression in Barrett s esophagus. Mod. Pathol. 74 397-403. 

Walch, A., Specht, K., Bink, K., Zitzelsberger, H., Braselmann, H., Bauer, M., Aubele, M., Stein, H., Siewert, J. R., Hofler, H., and Wemer, M. 2001. Her-2/new gene amplification, elevated mRNA expression, and protein overexpression in the metaplasia-dysplasia-adenocarcinoma sequence of Barrett s esophagus. Lab. Invest. 57 791-2001. 

Lanas A Potent gastric acid inhibition in the management of Barrett s esophagus. Drugs. 2005 65(suppl 1) 75-82. 

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