Assessment and management of Barrett's disease - Essay Example

This condition is seen more commonly in later age. Barrett’s esophagus is a pre malignant condition in which changes of dysplasia and carcinoma reported. Patients having Barrett’s disease have 30-40 fold increase risk of developing carcinoma- esophagus. To critically understand the disease, first we have to learn normal esophageal defence mechanism because most of the cases this disease is result of failure of esophageal defense mechanism. The lower esophageal sphincter, which is a localized area of specialized smooth muscles cited at distal end of the esophagus, is the main barrier to reflex.

This sphincter is normally contracted thus creating a zone of high pressure so preventing the passage of gastric contents into the esophagus. In normal subjects the esophageal sphincter relaxes during swallowing but at other times there are spontaneous transient relaxations. In those with reflex esophagitis, reflex is increased because the normal or resting pressure of the sphincter is reduced and number of transient relaxations is increased because the sphincter is situated below the diaphragm, its high pressure is reinforced by intra abdominal pressure, moreover the oblique entry of esophagus into the stomach ensures that the intra abdominal esophagus is closed when the stomach is distended.

These mechanisms are lost when the lower esophageal sphincter moves proximally to be situated above the diaphragm. Once reflex has occurred, rapid clearance of acid from the esophagus into stomach limits its contact with esophageal mucosa and this effective clearance depends upon secondary peristalsis and the presence of saliva and is enhanced by the erect position. It is impaired in supine position. Barrett’s disease is commonly seen in later age groups. It is divided into short (< 3 cm) segment and long segment (> 3 cm), according to the length of