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Barretts Esophagus

Barrett’s Esophagus: Pathogenesis, clinical findings and complications Gastroesophageal Reflux Disease (GERD) Authors: Sophia Khan Reviewers: Claire Song Shahab Marzoughi Sylvain Coderre* * MD at time of publication Reflux of stomach acid, bile salts + digestive enzymes through lower esophageal sphincter (located at junction between esophagus and stomach) Chronic reflux exposure to squamous epithelium (cells lining distal esophagus) Squamous epithelial cells release inflammatory cytokines: interleukin-8 and interleukin-1beta Inflammation of squamous epithelium Adaptive changes of squamous epithelium to prevent damage by acidic reflux Migration of stem cells in gastric cardia (proximal region of the stomach) into distal esophagus Replacement of esophageal squamous epithelium by gastric columnar epithelium Conversion (metaplasia) of normal esophageal squamous epithelium into abnormal gastric columnar epithelium with interspersed goblet cells Z line (the squamocolumnar junction between the esophagus and stomach) is irregular and displaced proximally on esophagus on endoscopy Heartburn (retrosternal burning sensation from stomach reflux) Regurgitation (involuntary expulsion of stomach content back into esophagus) Development of goblet cells (intestinal mucus-producing cells) within esophageal epithelium Abnormal presence of goblet cells on histology of distal esophagus Abnormal presence of columnar epithelial cells on histology of distal esophagus ↑ Atypical proliferation & ↓ apoptosis of Barrett’s epithelial cells Dysplasia (disordered growth of cells with the potential to develop into cancer) of Barrett’s epithelium Esophageal adenocarcinoma Improper division of nuclear chromatin (packaged DNA) Cellular nuclei increase in size due to retained chromatin from improper division Excess chromatin absorbs more stain during histology Double- stranded DNA breaks Nuclear enlargement on histology Continued acidic reflux causes oxidative DNA damage Hyperchromatic (darkly stained) nuclei on histology Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Dec 15, 2024 on www.thecalgaryguide.com