Page 4 - 03- Barrett Esophagus

history of BE or EAC (ACG), or patients with multiple risk factors (1,2)[B].
Screening for BE in the general population with GERD is not routinely recommended (1,2)
[C].

Initial Tests (lab, imaging)
None
Helicobacter pylori testing is not indicated. Meta-analyses show an inverse relationship
between H. pylori infections and BE, which may be related to decreased acid production.
No current biomarkers are effective for diagnosis; some under investigation for risk
stratification (1)[B]

Diagnostic Procedures/Other
Endoscopy: Visual identification of columnar epithelium (reddish, velvety appearance)
replacing squamous epithelium (pale, glossy appearance) of the distal esophagus is standard
for diagnosis/monitoring.
Biopsies are needed to confirm the diagnosis.
Classify disease extent: long segment (≥3 cm) versus short segment (<3 cm).
The Prague grading system used to describe BE using the squamocolumnar junction and GEJ.
“C” represents circumferential extent of the columnar changes. “M” indicates the maximal
proximal extent of columnar mucosa.
Advanced imaging techniques, such as narrow band imaging (NBI) and confocal laser
endomicroscopy (not in routine use), may help identify dysplasia.
Consider brush cytology with wide-area transepithelial sampling increases detection of
dysplasia (3)[A].
Systematic endoscopic biopsies confirm diagnosis:
– Seattle protocol: four-quadrant biopsies at regular intervals with biopsies of visible mucosal
irregularities; more time-consuming but higher diagnostic yield than random biopsies (1)
[A]
– Capsule endoscopy has lower sensitivity than conventional endoscopy.
Test Interpretation
Specialized intestinal metaplasia (also called specialized columnar epithelium) is diagnostic (4)
[C].
Diagnosis of dysplasia (and grade) should be confirmed by two gastrointestinal pathologists
before treatment. Benign BE is established by a single pathologist report (4)[C].
Cardia-type columnar epithelium may predispose to malignancy (unclear risk); International
Consensus Group recommends defining BE by the presence of columnar mucosa in the
esophagus (noting if intestinal metaplasia is present) (4)[C].
If screening endoscopy reveals erosive esophagitis, repeat endoscopy after 8 to 12 weeks of
proton pump inhibitor (PPI) therapy to exclude underlying BE; defer biopsies until healing
occurs (2)[C].

TREATMENT

MEDICATION
The goal of medical therapy is to control GERD and reduce esophagitis.