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Barrett Esophagus Clinical Presentation

  • Author: Mark H Johnston, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
 
Updated: Jun 22, 2016
 

History and Physical Examination

History

The classic history for a patient with Barrett esophagus is a middle-aged (55 y) white man with a chronic history of gastroesophageal reflux; for example, pyrosis, acid regurgitation, and, occasionally, dysphagia. Although this is a classic history, some patients may deny any symptoms.

Physical

No unique physical examination characteristics are evident in patients with Barrett esophagus other than those that would be found in patients with chronic GERD.

 
 
Contributor Information and Disclosures
Author

Mark H Johnston, MD Associate Professor of Medicine, Uniformed Services University of the Health Sciences; Consulting Staff, Lancaster Gastroenterology, Inc

Mark H Johnston, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Coauthor(s)

John A Eastone, MD 

John A Eastone, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Marco G Patti, MD Professor of Surgery, Director, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine

Marco G Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American Surgical Association, American College of Surgeons, American Gastroenterological Association, American Medical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, Western Surgical Association

Disclosure: Nothing to disclose.

Chief Editor

Praveen K Roy, MD, AGAF Chief of Gastroenterology, Presbyterian Hospital; Medical Director of Endoscopy, Presbyterian Medical Group; Adjunct Associate Research Scientist, Lovelace Respiratory Research Institute

Praveen K Roy, MD, AGAF is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

John A Eastone, MD Gastroenterology Fellow, Bethesda and Walter Reed Army Medical Center; Instructor, Department of Internal Medicine, F Edward Herbert School of Medicine, Uniformed Services University of the Health Sciences

John A Eastone, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Ronnie Fass, MD Chief of Gastroenterology, Southern Arizona VA Health Care System; Professor of Medicine, Division of Gastroenterology, University of Arizona School of Medicine

Ronnie Fass, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Motility Society, American Society for Gastrointestinal Endoscopy, and Israel Medical Association

Disclosure: Takeda Pharmaceuticals Grant/research funds Conducting research; Takeda Pharmaceuticals Consulting fee Consulting; Takeda Pharmaceuticals Honoraria Speaking and teaching; Vecta Consulting fee Consulting; XenoPort Consulting fee Consulting; Eisai Honoraria Speaking and teaching; Wyeth Pharmaceuticals Conducting research; AstraZeneca Grant/research funds Conducting research; Eisai Consulting fee Consulting

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

References
  1. Barrett NR. Chronic peptic ulcer of the oesophagus and 'oesophagitis'. Br J Surg. 1950 Oct. 38(150):175-82. [Medline].

  2. Allison PR, Johnstone AS. The oesophagus lined with gastric mucous membrane. Thorax. 1953 Jun. 8(2):87-101. [Medline].

  3. Barrett NR. The lower esophagus lined by columnar epithelium. Surgery. 1957 Jun. 41(6):881-94. [Medline].

  4. Paull A, Trier JS, Dalton MD, Camp RC, Loeb P, Goyal RK. The histologic spectrum of Barrett's esophagus. N Engl J Med. 1976 Aug 26. 295(9):476-80. [Medline].

  5. Thrift AP. Determination of risk for Barrett's esophagus and esophageal adenocarcinoma. Curr Opin Gastroenterol. 2016 Jul. 32 (4):319-24. [Medline].

  6. Lin D, Kramer JR, Ramsey D, Alsarraj A, Verstovsek G, Rugge M, et al. Oral Bisphosphonates and the Risk of Barrett's Esophagus: Case-Control Analysis of US Veterans. Am J Gastroenterol. 2013 Jul 16. [Medline].

  7. Boggs W. Oral Bisphosphonates Linked to Higher Risk of Barrett's Esophagus. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/809310. Accessed: August 20, 2013.

  8. Ronkainen J, Aro P, Storskrubb T, Johansson SE, Lind T, Bolling-Sternevald E, et al. Prevalence of Barrett's esophagus in the general population: an endoscopic study. Gastroenterology. 2005 Dec. 129(6):1825-31. [Medline].

  9. Schneider A, Gottrand F, Bellaiche M, et al. Prevalence of Barrett esophagus in adolescents and young adults with esophageal atresia. Ann Surg. 2015 Dec 28. [Medline].

  10. Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA. 1991 Mar 13. 265(10):1287-9. [Medline].

  11. Pera M, Cameron AJ, Trastek VF, Carpenter HA, Zinsmeister AR. Increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction. Gastroenterology. 1993 Feb. 104(2):510-3. [Medline].

  12. Allan EA, Miller R, Going JJ. Aneusomy detected by fluorescence in-situ hybridization has high positive predictive value for Barrett's dysplasia. Histopathology. 2015 Oct. 67 (4):451-6. [Medline].

  13. Haag S, Nandurkar S, Talley NJ. Regression of Barrett's esophagus: the role of acid suppression, surgery, and ablative methods. Gastrointest Endosc. 1999 Aug. 50(2):229-40. [Medline].

  14. Rayner CJ, Gatenby P. Effect of antireflux surgery for Barrett's esophagus: long-term results. Minerva Chir. 2016 Jun. 71 (3):180-91. [Medline].

  15. Krishnamoorthi R, Singh S, Ragunathan K, A Katzka D, K Wang K, G Iyer P. Risk of recurrence of Barrett's esophagus after successful endoscopic therapy. Gastrointest Endosc. 2016 Jun. 83 (6):1090-1106.e3. [Medline].

  16. Zhao Z, Pu Z, Yin Z, et al. Dietary fruit, vegetable, fat, and red and processed meat intakes and Barrett's esophagus risk: a systematic review and meta-analysis. Sci Rep. 2016 Jun 3. 6:27334. [Medline].

  17. Prasad GA, Wang KK, Buttar NS, Wongkeesong LM, Krishnadath KK, Nichols FC 3rd, et al. Long-term survival following endoscopic and surgical treatment of high-grade dysplasia in Barrett's esophagus. Gastroenterology. 2007 Apr. 132(4):1226-33. [Medline].

  18. Brown T. Barrett's Esophagus: Endoluminal Therapy Safe, Effective. Medscape Medical News. February 15, 2013. Available at http://www.medscape.com/viewarticle/779427. Accessed: March 11, 2013.

  19. Guarner-Argente C, Buoncristiano T, Furth EE, Falk GW, Ginsberg GG. Long-term outcomes of patients with Barrett's esophagus and high-grade dysplasia or early cancer treated with endoluminal therapies with intention to complete eradication. Gastrointest Endosc. 2013 Feb. 77(2):190-9. [Medline].

  20. Nayna L, Emma W, Vani K. Radiofrequency ablation for low-grade dysplasia in Barrett's esophagus. Curr Opin Gastroenterol. 2016 Jul. 32 (4):294-301. [Medline].

  21. Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett's esophagus with dysplasia. N Engl J Med. 2009 May 28. 360(22):2277-88. [Medline]. [Full Text].

  22. Brooks M. Ablation beats surveillance for Barrett esophagus and low-grade dysplasia. Medscape Medical News. March 27, 2014. [Full Text].

  23. Phoa KN, van Vilsteren FG, Weusten BL, Bisschops R, Schoon EJ, Ragunath K, et al. Radiofrequency ablation vs endoscopic surveillance for patients with Barrett esophagus and low-grade dysplasia: a randomized clinical trial. JAMA. 2014 Mar 26. 311(12):1209-17. [Medline].

  24. Mönkemüller K. Radiofrequency ablation for Barrett esophagus with confirmed low-grade dysplasia. JAMA. 2014 Mar 26. 311(12):1205-6. [Medline].

  25. Agoston AT, Strauss AC, Dulai PS, et al. Predictors of treatment failure after radiofrequency ablation for intramucosal adenocarcinoma in Barrett esophagus: a multi-institutional retrospective cohort study. Am J Surg Pathol. 2015 Dec 5. [Medline].

  26. Overholt BF, Panjehpour M, Haydek JM. Photodynamic therapy for Barrett's esophagus: follow-up in 100 patients. Gastrointest Endosc. 1999 Jan. 49(1):1-7. [Medline].

  27. Sampliner RE, Fennerty B, Garewal HS. Reversal of Barrett's esophagus with acid suppression and multipolar electrocoagulation: preliminary results. Gastrointest Endosc. 1996 Nov. 44(5):532-5. [Medline].

  28. Allison H, Banchs MA, Bonis PA, Guelrud M. Long-term remission of nondysplastic Barrett's esophagus after multipolar electrocoagulation ablation: report of 139 patients with 10 years of follow-up. Gastrointest Endosc. 2011 Apr. 73(4):651-8. [Medline].

  29. Boggs W. PPIs may reduce esophageal cancer risk in Barrett's esophagus. Reuters Health Information. November 26, 2013. [Full Text].

  30. Bremner RM, Mason RJ, Bremner CG, DeMeester TR, Chandrasoma P, Peters JH, et al. Ultrasonic epithelial ablation of the lower esophagus without stricture formation. A new technique for Barrett's ablation. Surg Endosc. 1998 Apr. 12(4):342-6; discussion 346-7. [Medline].

  31. Cameron AJ. Epidemiology of columnar-lined esophagus and adenocarcinoma. Gastroenterol Clin North Am. 1997 Sep. 26(3):487-94. [Medline].

  32. Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK, et al. Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med. 1982 Dec 16. 307(25):1547-52. [Medline].

  33. Johnston CM, Schoenfeld LP, Mysore JV, Dubois A. Endoscopic spray cryotherapy: a new technique for mucosal ablation in the esophagus. Gastrointest Endosc. 1999 Jul. 50(1):86-92. [Medline].

  34. Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A. Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology. 1986 Oct. 91(4):897-904. [Medline].

  35. Pereira-Lima JC, Busnello JV, Saul C, Toneloto EB, Lopes CV, Rynkowski CB, et al. High power setting argon plasma coagulation for the eradication of Barrett's esophagus. Am J Gastroenterol. 2000 Jul. 95(7):1661-8. [Medline].

  36. Sampliner RE. Ablative therapies for the columnar-lined esophagus. Gastroenterol Clin North Am. 1997 Sep. 26(3):685-94. [Medline].

  37. Sampliner RE. Practice guidelines on the diagnosis, surveillance, and therapy of Barrett's esophagus. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol. 1998 Jul. 93(7):1028-32. [Medline].

  38. Singh S, Garg SK, Singh PP, Iyer PG, El-Serag HB. Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett's oesophagus: a systematic review and meta-analysis. Gut. 2013 Nov 12. [Medline].

  39. Spechler SJ, Goyal RK. The columnar-lined esophagus, intestinal metaplasia, and Norman Barrett. Gastroenterology. 1996 Feb. 110(2):614-21. [Medline].

  40. Ter RB, Castell DO. Gastroesophageal reflux disease in patients with columnar-lined esophagus. Gastroenterol Clin North Am. 1997 Sep. 26(3):549-63. [Medline].

  41. Wong RKH. Barrett's esophagus. Pract Gastroenterol. 2000. 24:15-35.

  42. Hagen CE, Lauwers GY, Mino-Kenudson M. Barrett esophagus: diagnostic challenges. Semin Diagn Pathol. 2014 Mar. 31 (2):100-13. [Medline].

  43. Dunbar KB, Spechler SJ. Controversies in Barrett esophagus. Mayo Clin Proc. 2014 Jul. 89 (7):973-84. [Medline].

  44. Jankowski J, Bennett C, Jankowski JA. Management of Barrett esophagus: a practical guide for clinicians based on the BADCAT and BoB CAT recommendations. Pol Arch Med Wewn. 2015 Oct 28. 125 (10):765-70. [Medline].

  45. Iwakiri K, Kinoshita Y, Habu Y, et al. Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015. J Gastroenterol. 2016 Jun 21. [Medline].

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Barrett esophagus (BE). The salmon-pink area has specialized intestinal metaplasia. The white area is squamous epithelium.
Cryoablation of esophageal lining in Barrett esophagus (BE). This is one of the newest experimental ablative therapies for the esophagus performed at the author's laboratory.
Blistering of the esophageal mucosal layer after cryoablation in Barrett esophagus (BE).
 
 
 
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