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Short Barrett: prevalence and risk factors
C R de Mas1, M Krämer, E Seifert
1Dept. of Internal Medicine I, Klinikum Kemperhof, Koblenz, Germany.
Scandinavian Journal of Gastroenterology
|December 3, 1999
Summary
Specialized columnar epithelium (SCE) is more common than Barrett esophagus in the gastro-esophageal junction. Early detection of short Barrett through careful examination can improve prognosis for patients at risk of Barrett carcinoma.
Area of Science:
- Gastroenterology
- Oncology
- Pathology
Background:
- Increasing incidence of gastro-esophageal junction adenocarcinoma necessitates improved early diagnosis.
- Classical Barrett esophagus (>3 cm) is a known precancerous condition.
- Specialized columnar epithelium (SCE) in the gastro-esophageal transitional zone (short Barrett) is also a potential precursor.
Purpose of the Study:
- To determine the frequency of SCE in the gastro-esophageal junction.
- To identify clinical and endoscopic features associated with short Barrett.
Main Methods:
- 370 patients underwent esophagogastroduodenoscopy (OGD) between September 1995 and February 1996.
- Histological examination of the gastro-esophageal transitional zone was performed.
Main Results:
- Classical Barrett esophagus incidence was 4.6%.
- Microscopic SCE was found in 13.6% of patients.
- Short Barrett was associated with reflux symptoms (OR 4.7), irregular 'tongues' in the cardia (OR 2.8), and reflux esophagitis. Patients with both reflux symptoms and 'tongues' had an OR of 13.16.
Conclusions:
- Selective biopsy of the gastro-esophageal junction is recommended for patients with reflux symptoms and irregular 'tongues', even with a normal gross appearance.
- This approach aims to detect patients at risk for Barrett carcinoma.
- Careful history-taking and histological assessment improve the detection rate of short Barrett.