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Barrett' Esophagus

Posted Sep 22 2008 5:37pm
In 1950 Dr. Norman Barrett, in England, was using a new technique to look inside the body. Through an illuminated, rigid, metal tube in the mouth he looked down the throat into the esophagus. The lining of the food tube was a pale, pink similar to the inside of the mouth. In some individuals he observed the lining of the stomach located in the lower esophagus. The lining of the stomach is quite distinctive being a lush, reddish, appearance. He thus described a "tubular stomach". Utilizing this new technology, Dr. Barrett was the first to describe these findings. Thus it became known as Barrett's esophagus. The siginfigance of his findings (glandular tissue lining the lower esophagus) were unknown and as often is the case initially misunderstood.
We now know the lining of the esophagus undergoes this "change" as a result of reflux of stomach/digestive contents. The process of tissue changing from one type to another type is called metaplasia. Metaplasia is never a good thing. The pale delicate lining of the lower esophagus (the normal lining is called squamous epithelium) under goes metaplastic transformation to the lush, reddish, glandular tissue normally found only in the lining of the stomach. This type of tissue is called columnar epithelium. It is as if the body were trying to form a "callous" to protect itself from the harsh digestive juices and corrosive stomach acid. This type of lining in the esophagus is characteristic in appearance and is technically called a columnar lined esophagus. At the time of endoscopy biopsies are taken of this abnormal appearing tissue.
As time goes by continued reflux (years) may allow this glandular lining to undergo even further abnormal change when viewed under the microscope. If the biopsy speciman reveals the presence of Goblet cells (they have the ability to produce mucus) we now have, what in modern terminology, is called Barrett' esophagus. This tissue type is reffered to as specialized intestinal metaplasia. This is the first step in the direction of potenitally developing cancer of the esophagus. The next step in continued progression is called dysplasia. Dysplasia can lead to cancer and is thus a very troublesome finding.
To put this in its proper prospective you must realize that in the worst case situation only 1/2% of patients with Barrett's esophagus will delelope cancer per year.
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