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Barrett's esophagus and achalasia
Jin-Ping Guo1, Philip B Gilman, Rebecca M Thomas
1Division of Gastroenterology, Samaritan Program, Temple University Health System, Temple University Hospital, Philadelphia, Pennsylvania, USA.
Journal of Clinical Gastroenterology
|March 22, 2002
Summary
Two achalasia patients developed Barrett's esophagus, one before treatment and another after pneumatic dilation. This condition, especially in achalasia patients, elevates the risk of dysplasia and adenocarcinoma.
Area of Science:
- Gastroenterology
- Esophageal Diseases
- Oncology
Background:
- Achalasia, a rare esophageal motility disorder, is associated with an increased risk of Barrett's esophagus.
- Barrett's esophagus, a premalignant condition, involves the replacement of normal squamous epithelium with specialized columnar epithelium.
- Gastroesophageal reflux is the typical mechanism for Barrett's esophagus development in achalasia patients.
Observation:
- Two unusual cases of achalasia with documented Barrett's esophagus are presented.
- One patient had pre-existing Barrett's esophagus, while the other developed it after pneumatic dilation therapy.
- Both patients exhibited low-grade dysplasia in the esophageal tissue.
Findings:
- This report includes 30 cases of Barrett's esophagus in achalasia patients.
- Barrett's esophagus was diagnosed post-esophagomyotomy in 73% of reported cases.
- Adenocarcinoma developed in 20% of achalasia patients with Barrett's esophagus.
- The development of Barrett's esophagus after pneumatic dilation alone is unprecedented in reported cases.
Implications:
- Patients with achalasia and Barrett's esophagus face a heightened risk of dysplasia and adenocarcinoma.
- The findings suggest a need for vigilant surveillance in achalasia patients, particularly those with Barrett's esophagus.
- Further research is warranted to understand the specific mechanisms and risk factors involved.