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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 .
Acute esophageal necrosis (AEN), black esophagus, or Gurvits syndrome is a rare esophageal disorder. AEN defines itself with dark pigmentation of the esophagus , found during an upper gastrointestinal endoscopy . [ 2 ]
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).
The diaphragm separates the chest from the abdomen. The esophagus (swallowing tube) passes through the hiatal opening in the diaphragm to reach the stomach. With a hiatal hernia, part of the stomach is displaced upwards into the chest (Figure 1). Large hiatal hernias may cause chronic gastrointestinal blood loss leading to iron deficiency anemia.
Portal hypertensive gastropathy can also be treated with endoscopic treatment delivered through a fibre-optic camera into the stomach. Argon plasma coagulation and electrocautery have both been used to stop bleeding from ectatic vessels, and to attempt to obliterate the vessels, but have limited utility if the disease is diffuse. [8] [10]