Barrett's esophagus pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amresh Kumar MD [2]

Overview

Barrett's esophagus is marked by the presence of columnar epithelium in the lower esophagus, replacing the normal squamous cell epithelium; an example of metaplasia. The columnar epithelium is better able to withstand the erosive action of the gastric secretions; however, this metaplasia confers an increased cancer risk of the adenocarcinoma type.[1][2]

Pathophysiology

Pathogenesis

Genetics

  • The development of Barrett's esophagus is the result of multiple genetic mutations including mutations on chromosome 11p in European ancestry[3], genetic mutation of MGST1[4], mutations of genes GDF7 and TBX5[5] and polymorphisms in genes in the androgen pathway[6].

Associated Conditions

Gross Pathology

By Nephron Source: Libre Pathology

Microscopic Pathology

  • On microscopic histopathological analysis, gastric junctional type epithelium, gastric fundus type epithelium and specialized intestinal columnar metaplasia are characteristic findings of Barrett's esophagus.[12]


Histology of Barrett's esophagus ([By Nephron (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons])

References

  1. Fléjou J (2005). "Barrett's oesophagus: from metaplasia to dysplasia and cancer". Gut. 54 Suppl 1: i6–12. PMID 15711008.
  2. Rumiato E, Boldrin E, Malacrida S, Realdon S, Fassan M, Morbin T; et al. (2017). "Detection of genetic alterations in cfDNA as a possible strategy to monitor the neoplastic progression of Barrett's esophagus". Transl Res. 190: 16–24.e1. doi:10.1016/j.trsl.2017.09.004. PMID 29066320.
  3. Sun X, Chandar AK, Canto MI, Thota PN, Brock M, Shaheen NJ; et al. (2017). "Genomic regions associated with susceptibility to Barrett's esophagus and esophageal adenocarcinoma in African Americans: The cross BETRNet admixture study". PLoS One. 12 (10): e0184962. doi:10.1371/journal.pone.0184962. PMC 5657624. PMID 29073141.
  4. Buas MF, He Q, Johnson LG, Onstad L, Levine DM, Thrift AP; et al. (2017). "Germline variation in inflammation-related pathways and risk of Barrett's oesophagus and oesophageal adenocarcinoma". Gut. 66 (10): 1739–1747. doi:10.1136/gutjnl-2016-311622. PMC 5296402. PMID 27486097.
  5. Becker J, May A, Gerges C, Anders M, Schmidt C, Veits L; et al. (2016). "The Barrett-associated variants at GDF7 and TBX5 also increase esophageal adenocarcinoma risk". Cancer Med. 5 (5): 888–91. doi:10.1002/cam4.641. PMC 4864818. PMID 26783083.
  6. Ek WE, Lagergren K, Cook M, Wu AH, Abnet CC, Levine D; et al. (2016). "Polymorphisms in genes in the androgen pathway and risk of Barrett's esophagus and esophageal adenocarcinoma". Int J Cancer. 138 (5): 1146–52. doi:10.1002/ijc.29863. PMC 4715576. PMID 26414697.
  7. von Schrenck T (2000). "[Diagnosis of gastroesophageal reflux and Barrett esophagus]". Zentralbl Chir. 125 (5): 414–23. PMID 10929625.
  8. Minacapelli CD, Bajpai M, Geng X, Cheng CL, Chouthai AA, Souza R; et al. (2017). "Barrett's metaplasia develops from cellular reprograming of esophageal squamous epithelium due to gastroesophageal reflux". Am J Physiol Gastrointest Liver Physiol. 312 (6): G615–G622. doi:10.1152/ajpgi.00268.2016. PMID 28336546.
  9. Wipff J, Allanore Y, Soussi F, Terris B, Abitbol V, Raymond J; et al. (2005). "Prevalence of Barrett's esophagus in systemic sclerosis". Arthritis Rheum. 52 (9): 2882–8. doi:10.1002/art.21261. PMID 16142744.
  10. Drahos J, Li L, Jick SS, Cook MB (2016). "Metabolic syndrome in relation to Barrett's esophagus and esophageal adenocarcinoma: Results from a large population-based case-control study in the Clinical Practice Research Datalink". Cancer Epidemiol. 42: 9–14. doi:10.1016/j.canep.2016.02.008. PMC 4899201. PMID 26972225.
  11. Drahos J, Ricker W, Parsons R, Pfeiffer RM, Warren JL, Cook MB (2015). "Metabolic syndrome increases risk of Barrett esophagus in the absence of gastroesophageal reflux: an analysis of SEER-Medicare Data". J Clin Gastroenterol. 49 (4): 282–8. doi:10.1097/MCG.0000000000000119. PMC 4176548. PMID 24671095.
  12. Booth CL, Thompson KS (2012). "Barrett's esophagus: A review of diagnostic criteria, clinical surveillance practices and new developments". J Gastrointest Oncol. 3 (3): 232–42. doi:10.3978/j.issn.2078-6891.2012.028. PMC 3418534. PMID 22943014.

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