Sanjeev Slehria, MD, Prateek Sharma, MD

Disclosures

Curr Opin Gastroenterol. 2003;19(4) 

In This Article

Short-Segment Barrett Esophagus

Traditionally the endoscopic diagnosis of Barrett esophagus has been based on the findings of at least 3 cm of the distal esophagus lined by columnar epithelium. Segments of columnar epithelium with intestinal metaplasia less than 3 cm long have been referred to as short-segment Barrett esophagus (SSBE). However, not all patients with short lengths of columnar mucosa in the distal esophagus have intestinal metaplasia on biopsy. In a study of 570 patients undergoing upper endoscopy, Barrett esophagus was suspected in 146 patients; however, only 60 patients had a diagnosis confirmed by biopsy and SSBE was correctly diagnosed only 25% of the time.[10] In a study conducted in Kansas City, more than 20% of patients with suspected SSBE without intestinal metaplasia on the initial endoscopy had evidence of intestinal metaplasia (ie, proven SSBE) on repeat upper endoscopy with biopsy.[11] Until the routine and widespread use of special techniques in patients with suspected SSBE is performed, repeat endoscopy and biopsy may increase the yield of Barrett esophagus.

The pathophysiology of GERD has been extensively studied in patients with LSBE. Recently a group from Chile compared clinical, endoscopic, histologic, and functional features in patients with LSBE, SSBE, and intestinal metaplasia of the cardia.[12] All patients had esophageal manometric evaluation and 24-hour esophageal monitoring to determine the extent of acid and bile reflux. There were 174 patients with intestinal metaplasia of the cardia, 155 with LSBE, and 25 with SSBE. Compared with patients with LSBE and SSBE, patients with intestinal metaplasia of the cardia had significantly lower frequency of GERD symptoms, hiatal hernia, and erosive esophagitis; shorter durations of acid and bile reflux; and higher lower esophageal sphincter pressures. Between patients with SSBE and LSBE, significant differences were found in the frequency of hiatal hernia and duration of acid reflux (both greater in the patients with LSBE). Also, dysplasia was significantly more frequent in patients with LSBE than in those with SSBE or intestinal metaplasia in the cardia. These findings were confirmed by an Italian study in which the total percent of time esophagus was exposed to pH less than 4 was significantly higher in patients with LSBE as compared with those with SSBE.[13] Thus, GERD symptoms, signs, and physiologic abnormalities are found more often in patients with Barrett esophagus than in those with intestinal metaplasia in the cardia, and the duration of acid reflux in patients with LSBE is greater than that in patients with SSBE. This suggests that the extent of intestinal metaplasia in the esophagus is related directly to the severity of underlying GERD.

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