الفهرس 
Diagnosis of Barrett’s EsophagusOnly 14 pages are availabe for public view
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Abstract
Barrett’s esophagus is an acquired condition that results from chronic gostroesophageal reflux. It’s characterized by the metaplastic replacement of the normal squamous epithelium of the lower esophagus by columnar epithelium.
The clinical importance of Barrett’s esophagus through its link with adenocarcinoma of the distal esophagus via a well-characterized sequence from metaplasia to dysplasia to carcinoma.
The diagnosis of Barrett’s esophagus is based on the endoscopic findings of columnar epithelium lining the distal esophagus and confirmed by the presence of specialized intestinal metaplasia in esophageal biopsy specimens.
The early detection of neoplasia within Barrett’s esophagus is very important. Thus far, the most promising marker of increased cancer risk is the presence of dysplasia. Dysplasia is a histologic diagnosis.
The goals of antireflux therapy are to eliminate the symptoms and signs of gastroesophageal reflux disease and to prevent its complications. Usually this approach involves suppressing the secretion of gastric acid through the administration of H2-receptor antagonists or proton-pump inhibitors. Antireflux surgery attempts to create a barrier to gastroesophageal reflux through fundoplication. Medical and surgical therapies are highly effective for improving or eliminating the symptoms and signs of gastroesophageal reflux disease, but no antireflux therapy has been proved to decrease the risk of esophageal adenocarcinoma.
Endoscopic surveillance is performed primarily to identify dysplasia and to interfere at a point prior to progression to invasive carcinoma.
Patients with Barrett’s esophagus should undergo surveillance endoscopy and biopsy at intervals that are based on the presence or absence and grade of dysplasia. Patients without dysplasia should undergo endoscopy every two to three years.
When low-grade dysplasia is found, endoscopy should be repeated after 6 and 12 months and then yearly thereafter if there has been non progression. When high-grade dysplasia is identified, the diagnosis is confirmed, the American College of Gastroenterology endorses either of two management strategies: intensive endoscopic surveillance (every three months) or esophagectomy.
Local ablative treatments such as photodynamic therapy have shown promising results in reversal of Barrett’s esophagus without dysplasia or low-grade dysplasia. However, long-term data are not available, and the reported series are small.
Endoscopic mucosal resection is usually performed for focal lesions in Barrett’s esophagus or for complete removal of short segment Barrett’s esophagus.
Ablation therapy for patients with high grade dysplasia is currently a reasonable experimental approach for patients who have major comorbidity that precludes surgery or who are averse to surgical therapy.