Diseases

Endobrachyesophagus; Barrett's esophagus

Endobrachyesophagus; Barrett's esophagus


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Barrett's syndrome: disease of the esophagus

Barrett's esophagus is a special disease of the esophagus that usually occurs as a result of reflux disease. Changes in the mucous membrane lead to a shortening of the esophagus. The converted tissue carries an increased risk of cancer. Possible therapies are based on treatment methods for reflux and heartburn. If cancer precursors have already been reached or if Barrett's carcinoma has developed, surgical procedures are used. Regular check-ups of Barrett's syndrome using endoscopy and biopsy play an important role in cancer screening.

A brief overview

While the entire article provides comprehensive information about Barrett's esophagus, the following summary provides a quick overview of the most important facts about this special esophageal disease:

  • definition: Barrett's esophagus is an internal shortening of the esophagus caused by chronic reflux of gastric acid into the esophagus. This leads to specific changes in the mucous membrane on the inner wall of the esophagus.
  • Symptoms: Complaints do not always occur. Symptoms typically include heartburn, difficulty swallowing, and pain or burning sensation behind the breastbone.
  • causes: It is assumed that chronic and severe reflux diseases lead to the specific tissue changes of the epithelial layer in the esophagus. Permanent irritation and inflammation favor the formation of a resistant cylindrical epithelium, which carries a higher risk of degeneration.
  • diagnosis: For a reliable finding, endoscopic examinations, especially an esophageal mirroring, are carried out. In addition, the stage of the disease and any cancer precursors are determined using tissue samples.
  • treatment: The type (length less than or more than three centimeters) and the stage of the Barrett's esophagus are decisive in the treatment. The first means of choice are drug therapies. Surgery is an option for more serious cases, pre-cancerous or malignant carcinomas. Naturopathic treatments can be used as a support. In any case, attention should be paid to nutrition and a healthy lifestyle.

Definition

Barrett's esophagus (also obsolete endobrachyesophagus) is an endoscopic (internal) shortening of the esophagus (esophagus). This disease usually arises from chronic reflux of gastric acid into the esophagus, which leads to a change in the lining of the inner wall of the esophagus. This tissue change is a metaplastic circular transformation of the epithelium of the lower esophagus. This in turn justifies the internal shortening, because the transition between the stomach and esophagus is shifted upwards (headward).

A metaplastic transformation describes the process of changing one differentiated type of tissue into another (metaplasia). In a healthy person, the esophageal mucosa usually forms a multilayer, unhorned squamous epithelium as the top cell layer. When Barrett's syndrome develops in the lower esophagus, this is replaced by a single-layer, high-prismatic cylindrical epithelium (cylindrical epithelial metaplasia). The cylindrical epithelium corresponds to the typical epithelium of the intestinal mucosa and, in contrast to the squamous epithelium, forms so-called goblet cells (specialized cylindrical epithelium). The cylindrical epithelium is more resistant to the existing irritation, but carries a higher risk of degeneration.

Experts speak of a Barrett's esophagus in the narrower sense when it is a circular metaplasia, i.e. when the entire circumference of the esophagus is covered from the transition between the squamous and cylindrical epithelium (Z line) towards the oral cavity. In principle, a distinction is made between two versions: a short segment with a length of up to three centimeters (short segment Barrett's esophagus) and a slow segment with over three centimeters (long segment's Barrett esophagus).

The disease is named after the Australian-British surgeon Norman Barrett (1903-1979). According to various studies, one to four percent of gastroscopic examinations identify a Barrett's esophagus. Men are affected much more often than women.

Symptoms

The process of tissue conversion usually does not cause any complaints and those affected can remain symptom-free in the further course. Otherwise, the typical symptoms of an existing Barrett's esophagus resemble the symptoms of the possible previous illnesses. The following main symptoms occur in gastroesophageal reflux disease, esophagitis (esophagitis) and in Barrett's syndrome:

  • Acid regurgitation and heartburn,
  • Pain or burning sensation behind the breastbone,
  • Swallowing disorders (dysphagia).

Sequelae

Pronounced swallowing difficulties can also lead to weight loss for those affected. Permanent or severe reflux disease also increases the risk of developing esophageal cancer (esophageal cancer). About 10 percent of those with Barrett's esophagus develop Barrett's carcinoma in the lower esophagus at the transition to the stomach (adenocarcinoma). This type of cancer is formed from glandular cells in the mucous membrane. The risk of degeneracy is fundamentally higher with the slow segment characteristics.

Another possible consequence is ulceration (Barrett's ulcer). In addition, the inflammatory processes and scarring can also lead to a considerable narrowing of the esophagus (esophageal stricture).

Causes

Up to ten percent of those with reflux disease also develop Barrett's syndrome. The reason for the tissue change that has occurred has not been finally clarified. Inflammation in the lower esophagus caused by constant reflux (reflux esophagitis) is believed to cause certain signal and regeneration disorders in the affected cells in addition to permanent irritation.

In addition to the harmful acid effects of gastric juice, other external risk factors may also play a role in the development of the disease, such as an increased consumption of alcohol and nicotine. Barrett's esophagus is also thought to have a certain genetic disposition.

Diagnosis

Endoscopy is carried out to make a reliable diagnosis of Barrett's esophagus. In a single examination, not only the esophagus is usually examined endoscopically with a probe or a tube, but also the stomach (gaster) and the duodenum (duodenum). This is referred to by doctors as esophagogastroduodenoscopy, in common usage is spoken of a mirroring of the esophagus, stomach and intestines.

An additional collection of tissue samples (four quadrant biopsy) from conspicuous areas helps to differentiate between benign and malignant cell changes. Chromoendoscopy is often carried out beforehand, in which the special dyes used during endoscopy improve the diagnosis. The suspicious and conspicuously stained areas are specifically sampled for the subsequent histological examination.

Check-ups

If Barrett's esophagus has been diagnosed, regular endoscopic check-ups and tissue diagnostics are essential. However, there is no general consensus on the necessary frequency. Since the risk of degeneration in short-segment Barrett syndrome is very low according to expert opinion, routine examinations are not absolutely necessary or only advised at longer intervals. If there is a slow segment, there is a higher risk of developing cancer, which is why a (semi) annual check is advisable in these cases.

If there is no dysplasia (malformation and possible cancer precursor), further checks can be carried out less frequently (approximately every three years). Thus, the type and stage of Barrett's syndrome largely determine the frequency of endoscopies and are to be determined by experts depending on the patient case. In the first year after the diagnosis, however, one or two check-ups always make sense.

Treatment

An existing Barrett's esophagus does not have to be treated as long as no malignant changes are found. However, if symptoms occur, those affected can be helped with treatment methods for the reflux disease.

While targeted changes in diet and behavior can alleviate the symptoms of mild forms of reflux, medical treatment is usually necessary if the mucous membrane is damaged. At this stage, the first choice mostly falls on so-called proton pump inhibitors such as omeprazole or pantoprazole. These drugs are said to reduce or suppress the formation of stomach acid, thereby reducing reflux and its damaging effects.

If drug therapy is unsuccessful or other complications indicate, surgery may be an option. So far, so-called fundoplication (gastric cuff surgery) has been used most frequently. This leads to permanent healing of the reflux disease in over 90 percent of the patients. Other endoscopic anti-reflux therapies and the use of flexible magnetic tape are also increasingly available as alternative surgical methods. Relatively rarely is photodynamic therapy carried out, in which the Barrett's mucosa is said to recede into the normal squamous epithelium using laser treatment.

Taking into account family cancers and the results of the check-ups, radio frequency ablation (HALO ablation) may be advisable to remove the Barrett's mucosa if there is an increased risk of cancer.

In the case of malignant changes in the Barrett's esophagus (adenocarcinoma in the mucosa), endoscopic resection usually takes place. The malignant tissue is sucked in during the endoscopic examination and removed with a loop. This method offers many advantages over conventional surgical methodology. However, if the malignant changes have penetrated deep into the wall beneath the mucous membrane (submucosa), a surgical intervention is necessary, which should be carried out by experienced experts due to the existing risks.

Naturopathic treatment

Possible measures from naturopathy promise effective support, especially for mild symptoms of reflux disease and heartburn. However, alternative therapy methods can also be an important part of treatment for Barrett's esophagus. After operative interventions, the supplementary procedures can also serve as aftercare and reduce the likelihood of relapse.

Change of diet and lifestyle

Targeted changes in lifestyle and eating habits play a central role. The following measures are particularly important:

  • Abstaining from nicotine and alcohol,
  • Reduction of overweight,
  • regular and light sporting activity,
  • Diet with a sufficient amount of fruits, vegetables and fiber,
  • Avoidance of acidic foods,
  • Eating without time pressure,
  • Taking small meals,
  • Digestive walks, do not lie down after eating,
  • Sleeping with a raised upper body,
  • Stress relief.

So far, there is little proven evidence of which foods most often cause complaints in reflux. Experiences of sufferers have shown that acidic, sweet and sour, fatty, bitter and spicy (hot and salty) foods have a negative effect. This includes coffee, chocolate and alcoholic drinks.

Alternative naturopathic procedures for reflux and heartburn

Chamomile (roll cure with chamomile tea) is often used in phytotherapy for self-medication for heartburn. But other plants such as fennel, lemon balm, plantain and nettle are also suitable as natural herbal remedies.

Applications for homeopathy, Schuessler salts, acupuncture and special home remedies also offer other options for counteracting acid regurgitation and reflux.

Current state of research

An initiative of doctors and scientists at different German university clinics has brought together a consortium to research the genetic causes of Barrett's esophagus and Barrett's carcinoma. The Barrett Initiative and the Barrett Consortium make their own publications and other current findings from research and practice available to the general public. (tf, cs; updated on November 12th, 2018)

Further information:

Gastroesophageal reflux disease (reflux)
Inflammation of the esophagus (esophagitis)
heartburn

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. rer. nat. Corinna Schultheis

Swell:

  • Clinic for Visceral, Transplantation, Thoracic and Vascular Surgery University Hospital Leipzig AöR: Barrett Initiative - Patient Information (accessed: 06.07.2019), barrett-initiative.de
  • German Society for Gastroenterology, Digestive and Metabolic Diseases e.V .: S2k Guideline Gastroesophageal Reflux Disease, as of August 2014, dgvs.de
  • German Society for the Control of Diseases of the Gastrointestinal and Liver and Disorders of Metabolism and Nutrition (Gastro-Liga) e. V .: Heartburn guide, as of June 2017, gastro-liga.de
  • Krishnamoorthi. R. / et al .: Factors Associated With Progression of Barrett’s Esophagus: A Systematic Review and Meta-analysis. Clinical Gastroenterology and Hepatology 2018, cghjournal.org
  • Mayo Clinic: Barrett's esophagus (accessed: July 6, 2019), mayoclinic.org
  • Shaheen, Nicholas J. / Falk, Gary W / Iyer, Prasad / et al .: ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus, American Journal of Gastroenterology, 2016, journals.lww.com
  • UpToDate, Inc .: Barrett's esophagus: Epidemiology, clinical manifestations, and diagnosis (accessed: July 6, 2019), uptodate.com

ICD codes for this disease: K22ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.


Video: Barrett Esophagus (September 2022).


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