Barrett's esophagus. (Esophagoscopy Clinic).

A 48-year-old white man with a history of laryngopharyngeal reflux underwent 24-hour double-probe ambulatory pH testing. He denied any heartburn. This study demonstrated abnormal degrees of reflux in both his esophagus and pharynx. Transnasal esophagoscopy (TNE) detected an erythematous area in the lower third of his esophagus (figure). Biopsies were diagnostic for Barrett's esophagus.

Barrett's esophagus is a premalignant condition caused by chronic reflux. During the repetitive process of inflammation and repair, a metaplastic process occurs, and abnormal columnar epithelium that is normally seen in the stomach replaces the injured esophageal epithelium. Barrett's esophagus occurs in 3 to 15% of patients with gastroesophageal or laryngopharyngeal reflux. (1) The diagnosis is made by endoscopy with biopsy.

The greatest risk of Barrett's esophagus is the development of adenocarcinoma of the distal esophagus and gastric cardia. It is believed that Barrett's esophagus increases the relative risk of adenocarcinoma 30- to 125-fold. (2) Aggressive medical and surgical antireflux therapy is considered appropriate treatment along with regular-interval surveillance with multiple biopsies.

References

(1.) Spechler SJ. Clinical practice. Barrett's esophagus. N Engl J Med 2002;346:836-42.

(2.) Wijnhoven BP, Tilanus HW, Dinjens WN. Molecular biology of Barrett's adenocarcinoma. Ann Surg 2001;233:322-37.

From the Center for Voice Disorders, Department of Otolaryngology. Wake Forest University Medical Center, Winston-Salem, N.C.; www.thevoicecenter.org