Gastrointestinal system Flashcards
Barret esophagus
*squamous to columnar metaplasia in the lower esophagus due to chronic exposure to the acidic contents of the stomach
*precancerous (adenocarcinoma)
*risk factors include GERD, hiatal hernias; it is more common in males
*Patients with GERD often complain of burning midsternal chest pain, belching, or a sour taste in their mouth, especially after eating spicy or acidic foods or drinking alcohol or caffeine. Risk factors for GERD include obesity, pregnancy, older age, and smoking. Barrett esophagus is more likely to develop in Caucasian males, age >50, obese, and smokers. It is impossible to diagnose Barrett’s without endoscopy and biopsy.
*Ix:
-OGD and biopsy
*pathology:
gross: salmon-colored, irregular intestinal metaplasia, cloumnar epithelium with goblet cells (PAS-positive); dysplasia and cancer might coexist
Tr:
Lifestyle modification: weight loss and exclusion of spicy or acidic foods, caffeine, and alcohol from the diet to treat symptoms of GERD (first step)
Proton pump inhibitors (PPIs) and H2 blockers such as ranitidine to treat and prevent persistent symptoms of GERD
While overall risk of progression to adenocarcinoma is low in Barrett esophagus, the risk is higher if high grade dysplasia is also seen in the esophageal mucosa
If Barrett esophagus is concurrent with high grade dysplasia, endoscopic mucosal resection (EMR) is a treatment consideration
*physiology, dyring normal esophageal peristalsis, the VIP (vasoactive intestinal peptide) inhibits contraction of the LES, permiting the entry of the esophageal contents into the stomach; in GERD, the LES is too relaxed, allowing the contents of the stomach to backflow into the lower esophagus.
