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Barrett's esophagus is a condition in which there is an abnormal (metaplastic) change in the mucosal cells lining the lower portion of the esophagus, from stratified squamous epithelium to simple columnar epithelium with interspersed goblet cells that are normally present only in the small intestine and large intestine.
However, when present, symptoms may include difficulty swallowing , pain while swallowing (odynophagia), cough or globus sensation. [1] Whether esophageal inlet patches may cause other symptoms, such as chronic cough or laryngitis, is unclear. [1] Occasionally, esophageal inlet patches may be seen during a barium esophagram. [3]
Chronic inflammation caused by H. pylori infection in the stomach and GERD in the esophagus are seen as the primary instigators of metaplasia and subsequent adenocarcinoma formation. Initially, the transformed epithelium resembles the small intestine lining; in the later stages it resembles the lining of the colon .
Esophagogastric junction outflow obstruction (EGJOO) is an esophageal motility disorder characterized by increased pressure where the esophagus connects to the stomach at the lower esophageal sphincter. EGJOO is diagnosed by esophageal manometry.
Barrett's esophagus is the dominant pre-malignant lesion of esophageal adenocarcinoma, [18] and has prevalent epigenetic alterations. [ 19 ] Esophageal squamous-cell carcinomas may occur as second primary tumors associated with head and neck cancer , due to field cancerization (i.e. a regional reaction to long-term carcinogenic exposure).
Esophagitis can be asymptomatic; or can cause epigastric and/or substernal burning pain, especially when lying down or straining; and can make swallowing difficult . The most common cause of esophagitis is the reverse flow of acid from the stomach into the lower esophagus: gastroesophageal reflux disease (GERD).
Both of these features impair the ability of the esophagus to empty contents into the stomach. Patients usually complain of dysphagia to both solids and liquids. Dysphagia to liquids, in particular, is a characteristic of achalasia. Other symptoms of achalasia include regurgitation, night coughing, chest pain, weight loss, and heartburn.
A Type I tumor, located between 5 and 1cm proximal to the OGJ, is an adenocarcinoma that typically arises from an area of intestinal metaplasia of the esophagus and can infiltrate the OGJ from above. A Type II tumor, located between 1cm proximal and 2cm distal to the OGJ, is a true adenocarcinoma of the gastric cardia.