Etiology

BE results from severe gastroesophageal reflux diseases (GERD). It usually presents in the sixth decade of life with a male-to-female ratio of 3:1.

Anatomy

They occur most commonly in the distal third of the esophagus.

Pathophysiology

Refluxed gastric acid, proteases and bile erode normal squamous epithelium with residual pluripotential basal cells differentiate along varying lines. A wide variety of genetic events and mechanisms appear to play a role in the progression of Barrett's to adenocarcinoma. .Development of Barrett's is associated with chromosomal loss (4q, 5q, 16q,18q). Growth factors and cell adhesion molecules also may play a role (EGFR, c-erbB2 and src). However, a uniform molecular pathway has not been described.

Barrett's Mucosa

• Gastric fundus-type epithelium

• Junctional-type epithelium

• Specialized columnar epithelium — highest association with carcinoma

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