Barrett Esophagus patients present an annual 0,5% risk of developing an adenocarcinoma in the esophagus, which is a significantly higher risk compared to the rest of the population. A Barrett Esophagus diagnosis often occurs in elderly people, with an average age of 65, and it is more common in men than in women, especially in Caucasians and Hispanics. This illness is a gained anomaly, even though studies have shown that there are certain genetic conditions favoring the cell transformations that take place.
Gastroesophageal reflux disease represents the easiest to identify risk for the occurrence of the Barrett Esophagus, but due to the low percentage of patients with Barrett Esophagus in the GERD context there is the possibility for the condition to be favored by other risk factors who are equally important. Some of these factors include age, reflux symptom history, the intensification of reflux symptoms during the night, low tonus in the lower esophageal sphincter, complications associated with GERD – ulcer, hemorrhaging.
The Barrett Esophagus occurs due to trauma of the esophageal mucous, which, by adaptation or metaplasia, becomes a columnar epithelium. This adaptation is explained though increased resilience to acid manifested by the column cells compared to pavement cells.
The advancement of the Barrett Esophagus to neoplasm occurs early, when there are conditions for the selective advantaging of abnormal cell development. Chromosome aberrations or genetic mutations could lead to the inactivity of suppressing genes. Once these genes have been rendered inactive, the abnormal cells divide chaotically, proliferate, and the situation evolves towards neoplasm.
Symptoms of Barrett’s disease presented by patients are similar to those seen in patients suffering from GERD, which is why increased attention is required when faced with Symptoms of Barrett’s disease, with a differentiated diagnosis between the two types of afflictions. In addition, there are a great number of patients with Barrett’s disease or with adenocarcinoma that do not show any GERD specific symptoms. Indications issued by the American College of Gastroenterology recommend endoscopy for any patient with GERD symptoms, as screening criteria referring to age and race still spark debates on their relevance.
The definition of Barrett’s disease has changed in time, and today this condition is seen as a change in the esophageal epithelium, regardless of its length, which could be recognized during an endoscopy and can be confirmed through a biopsy as intestinal metaplasia, excluding the intestinal metaplasia of the cardium. What needs to be remembered here is that the positive biopsy needs to outline the calciform cells, patognomonic for the metaplastic changes.