Page 3 - 03- Barrett Esophagus

Male gender
White ethnicity—incidence in white males is much higher than white women and African
American men
Smoking history
Intra-abdominal obesity
Family history—at least one first-degree relative with BE or EAC

GENERAL PREVENTION
Weight loss, smoking cessation, robust intake of fruits and vegetables, and moderate wine
consumption may decrease risk of BE and lower progression to esophageal cancer (1)[C].

COMMONLY ASSOCIATED CONDITIONS
GERD, obesity, hiatal hernia

DIAGNOSIS

HISTORY
Assess underlying risk factors.
Common GERD symptoms: heartburn, regurgitation
Atypical symptoms include chest pain, odynophagia, chronic cough, water brash, globus
sensation, laryngitis, or wheezing.
Symptoms suggestive of complicated GERD or cancer include weight loss, anorexia,
dysphagia, odynophagia, hematemesis, or melena.
ALERT
BE often not symptomatic; up to 50% of EAC and BE patients do not report GERD.

PHYSICAL EXAM
No findings on physical exam are specific for BE.
Findings similar to GERD
DIFFERENTIAL DIAGNOSIS
Erosive esophagitis
Uncomplicated GERD
Hiatal hernia
DIAGNOSTIC TESTS & INTERPRETATION
Endoscopy with multiple biopsies demonstrating intestinal metaplasia extending ≥1 cm proximal
to the GEJ is required to diagnose BE.
Gastric cardia–type epithelium on pathology does not have clear malignant significance and
may reflect sampling error.
Specialized intestinal metaplasia at the GEJ: unclear significance, cancer risk difficult to assess
with varying definitions of GEJ landmarks

ALERT
Endoscopic screening is controversial and has not been prospectively studied. Consider
screening men with chronic GERD (>5 years) and/or frequent GERD symptoms with two or
more risk factors: age >50 years, white ethnicity, central obesity, smoking history, family