By:Sharmin Susiwala TY BPT

Barrett esophagus sometimes called Barrett syndrome or columnar epithelium lined lower oesophagus (CELLO), refers to an abnormal change (metaplasia) in the cells of the lower portion of the esophagus.

When the normal squamous epithelium lining of the esophagus is replaced by goblet cells(cells usually found lower in the gastrointestinal tract), Barrett's esophagus is diagnosed.

The medical significance of Barrett esophagus is its strong association with esophageal adenocarcinoma, a particularly lethal cancer.

An adaptation to chronic acid exposure from reflux esophagitis

Gastroesophageal reflux disease GERD

The change from normal to premalignant cells that indicate Barrett esophagus does not cause any particular symptoms.

Barrett esophagus, however, is associated with the following symptoms:

frequent and longstanding heartburn trouble swallowing (dysphagia) vomiting blood (hematemesis) pain under the breastbone where the esophagus meets the

stomach unintentional weight loss because eating is painful

The risk of developing Barrett esophagus is increased by central obesity (vs. peripheral obesity).

Barrett esophagus occurs due to chronic inflammation.

The principal cause of the chronic inflammation is GERD.

In this disease, acidic stomach, bile, small intestine and pancreatic contents cause damage to the cells of the lower esophagus.

Recently, it was shown that bile acids are able to induce intestinal differentiation, in gastroesophageal junction cells, through inhibition of the Epidermal growth factor receptor (EGFR) receptor and the protein kinase enzyme Akt.

Diagnosis of Barrett esophagus requires endoscopy (more specifically,esophagogastroduodenoscopy, a procedure in which a fibre optic cable is inserted through the mouth to examine the esophagus, stomach, and duodenum) and biopsy.

Barrett esophagus is marked by the presence of columnar epithelia in the lower esophagus, replacing the normal squamous cell epithelium—an example of metaplasia

The cells of Barrett esophagus, after biopsy, are classified into four general categories:

1. non-dysplastic2. low-grade dysplasia 3. high-grade dysplasia4. frank carcinoma5. High-grade dysplasia

 Treatment options for high-grade dysplasia include:- surgical removal of the esophagus (esophagectomy)- endoscopic treatments such as endoscopic mucosal

resection or radiofrequency ablation (destruction). Proton pump inhibitor drugs have not yet been proven to

prevent esophageal cancer.  Laser treatment is used in severe dysplasia, while overt

malignancy may require surgery, radiation therapy, or systemic chemotherapy.

Endoscopic mucosal resection (EMR) has also been evaluated as a management technique. Additionally an operation known as a Nissen fundoplication can reduce the reflux of acid from the stomach into the esophagus.

In a variety of studies, non-steroidal anti-inflammatory drugs (NSAIDS), like aspirin, have shown evidence of preventing esophageal cancer in Barrett esophagus patients.