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Discrete ulcers in Barrett's esophagus: relationship to acute gastrointestinal bleeding
P P Murphy1, P J Ballinger, B T Massey
1Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, USA.
Background And Study Aims:
Although discrete ulcers are a recognized complication of Barrett's esophagus, it is not clear how common discrete ulceration is in Barrett's mucosa. Furthermore, the relationship of gastrointestinal hemorrhage to Barrett's ulceration is unknown. These issues were investigated in this paper.
Methods:
Seventy-eight patients with histologically confirmed Barrett's esophagus were monitored by endoscopic surveillance over 1 to 11 years (mean 3.3 years). The incidence of a Barrett's ulcer was noted and its site recorded. The frequency of gastrointestinal hemorrhage at diagnosis or on follow-up was documented and the source of the bleeding was identified.
Results:
Discrete ulcers were identified in 36 of 78 patients (46%) at some time over the period of follow-up. Eight patients had two or more ulcers. Most of ulcers were in the distal esophagus; 86% of these were within 3 cm of the anatomic gastroesophageal junction. Nineteen patients (24%) either presented with active gastrointestinal bleeding or had bleeding at follow-up. In 15 of the 19 patients with bleeding (79%) a discrete Barrett's ulcer was the source of the hemorrhage.
Conclusions:
Ulceration is a common complication of Barrett's esophagus. These ulcers are usually located close the gastroesophageal junction and have a high incidence of bleeding.