Barretts Esophagus In Gastroesophageal Reflux Disease Biology Essay

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Gastroesophageal reflux disease, commonly known as acid reflux or GERD is a condition where stomach contents reflux of fluid into the esophagus backup or reflux. Liquid incitement and destruction of the mucosa (the cause of esophagus) esophageal signs of inflammation, although in some patients. (1) Ruminant's liquid usually contains acid that is generated by the stomach to help digest food, and pepsin. Pepsin is a protein in the stomach and digestive enzymes. The reflux of fluid may also contain an accumulation of bile in the stomach and duodenum. (1, 2)The acid liquid is considered that the most harmful ingredients reflux. Pepsin and bile also may damage the esophagus, but its role in the production of esophageal inflammation and damage is not as clear as the career of acid. (1, 2, 3, 5)

Gastroesophageal reflux disease can be considered symptoms of chronic heartburn. Although it can cause discomfort, occasional heartburn is not harmful. But if you have heartburn, often untreated, stomach acid can inflame the esophagus or swallowing tube, potentially narrowing it. (3, 5)Barrett's esophagus is a complication of chronic gastroesophageal reflux disease, especially white men. The acid can also change the cellular lining of your esophagus. This change, called Barrett's esophagus, and increase the chance of esophageal cancer. Initially, it was Barrett's esophagus consisted of stomach tissue replacing the usual squamous tissue lining the esophagus. Eventually lead to chronic inflammation and ulceration of the lower esophagus is generally to be replaced by cells normally found in the intestinal tract (intestinal metaplasia). (1, 3)

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Barrett's esophagus is metaplasia of the esophagus instead of normal cells lining, including a mixture of the stomach and intestinal cells. Intestinal lining include goblet cells and columnar cells. Few years, some scientists believe that there are two types of Barrett in the stomach (gastric) types of cells, intestinal cells in people attended the second replaced the normal lining. However, the current belief is that the only type of intestinal goblet cells in the presence of Barrett's esophagus diagnosis, regardless of what other types of cells exists. (1, 2, 5)

Gastroesophageal reflux develop Barrett's esophagus, only a small proportion. The contents of your stomach, you can also move to the throat, are attracted in the past the vocal cords and lungs where they can cause damage, with a hoarse voice, chronic cough or asthma.(6,7)

Anyone can develop gastroesophageal reflux disease at any age. You are more likely to develop as you age. Pregnant women are especially prone to GERD. Gastroesophageal reflux disease affects nearly one third of the adult U.S. population, to some extent at least once a month. Almost 10% of adults experience GERD weekly or daily. Not only adults, including infants and children with GERD. And not everyone with Barrett's esophagus had GERD. But long-term GERD are important risk factors. (2, 3, 5)

Anyone can develop Barrett's esophagus, but white male with long-term gastroesophageal reflux more likely to develop than others. Other risk factors are younger, a history of current or past smoking on the incidence of GERD. (3, 7)

Most acid reflux do not develop Barrett's esophagus. However, over time, in normal cells of patients with frequent reflux in the esophagus may be replaced by intestinal cells & gastric cells into cells of Barrett's esophagus. (2, 5)

Risk factors Of Barrett's esophagus in Gastroesophageal Reflux Disease

Factors that increase your risk of Barrett's esophagus include:

Chronic heartburn and acid reflux (3)

Being a man (3)

Being white man (3)

Being an older adult (3)

These symptoms of gastroesophageal reflux disease (GERD), more than 10 years may increase the risk of Barrett's esophagus. Gastric acid into the esophagus support, if you have GERD may damage the esophageal tissue, causing the signal changes of Barrett's esophagus. Men are more likely to develop Barrett's esophagus. White people have a greater risk for disease than do people of other races. Barrett's esophagus is more common in older people, but it can occur at any age. (3, 4)

Causes of Barrett's esophagus in Esophageal reflux disease

Gastroesophageal reflux lead to Barrett's esophagus. Under normal circumstances, the muscular ring at the bottom of the esophagus, called the lower esophageal sphincter (LES), to prevent acid reflux. This muscle is like belted open or closes the opening between the esophagus and stomach. Bites between it should be tightly closed when you do not eat.

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Gastroesophageal reflux disease, swallow and eat the lower esophageal sphincter relaxation, backup and burn or irritate the esophagus lining of the stomach contents and corrosive acid. Other factors of Barrett's esophagus are a fluid containing the acid produced by the stomach in the stomach. (2, 3, 4, 5, 6, 7)

In addition, the liquid may contain bile acids (from the liver to produce bile) and enzymes (produced by the pancreas) back into the stomach and duodenum. Acid from gastroesophageal reflux damage to esophagus. However, there is some evidence that the combination of bile and pancreatic enzymes and acid may be more damage than acid mono.

We do not know the accurate cause of gastroesophageal reflux disease. We do not know what makes the situation worse, or relax the lower esophageal sphincter or direct stimulation of the esophagus. (2, 3, 4, 5, 6, 7)

Abnormal esophageal contractions (5)

Diet - Fatty and fried foods, chocolate, garlic and onions, drinks with caffinee, acidic foods as citrus fruits and tomatoes, spicy foods, mint flavorings Eating habits (3,5)

Eating large meals, Eating before bedtime (3,5)

Hiatal herniae (3,5)

Lifestyle - Use of alcohol or cigarettes ,Obesity , poor posture(slouching) (3,5)

Medications - Blood pressure drugs called calcium channel blockers, theophylline (Tedral, Hydrophed, Marax, Bronchial, Quibron), nitrates,antihistamines (3,5)

Other medical conditions -pregnancy, diabetes (3,5)

Slow or prolonged emptying of the stomach (3,5)

Dietary habits and lifestyles, but also played a role. Fatty foods, peppermint, chocolate, wine, coffee, tea, relax the sphincter. Thus, the nicotine from cigarettes or chewing snuff causes the relaxation of LES.(3,5) Pregnancy-related hormonal changes may temporarily weaken the LES, too.(8,9) Obesity can lead to GERD, because the extra weight of the boost pressure in the abdomen can be "overwhelming" LES, reflux occurred. The same mechanism explains reflux can occur when you lean. (8, 9)A hiatal hernia (part of the stomach protrudes above the diaphragm into the chest), and poor esophageal muscle contraction, but also contribute to gastroesophageal reflux. (3, 5)

Hiatal hernia

The hiatal hernia is the diaphragm in the upper chest of the stomach protrudes above. The diaphragm is a muscular structure separate table of the abdomen of the thoracic organs. The diaphragm has an opening (break), allow the esophagus. Persistent cough, vomiting, nervousness, or sudden physical exertion can cause a part of the stomach through the opening of the hare. Obesity and pregnancy can worsen the condition. (3, 5, 6)

The backup of acid into the esophagus from the stomach is easier become by hiatal hernia. The hiatal hernia is very common in people over 50 years of age. Most people are unaware they have it until they develop gastroesophageal reflux disease. Bysurgery hernia repair, but this is usually not necessary unless the stomach becoming distorted or GERD symptoms are severe. (3, 5, 6)

Lower esophageal sphincter abnormalities

The action of the lower esophageal sphincter (LES) may be the most important factor (mechanism), in order to prevent reflux. Esophagus is a muscular tube which lengthens from the lower throat to the stomach. LES is a specialized ring of muscle around the lower end of the esophagus where it joins the stomach. Muscles, causing the active group are most of the time. This means that contracts and closing hills from the esophagus to the stomach channel. This shut down to prevent reflux. Ingestion of food or saliva of the group for a few seconds, relax, food or saliva enters the stomach through the esophagus, and then closed again. (6, 7)

Several different abnormalities of LES have been found in ​​patients with GERD. Two of which involve the function of the LES. The first is the abnormal contraction; thereby reducing its ability to prevent the return of LES is weak. The second is the abnormal relaxations of the LES, called transient LES relaxation. They are not normal, because it does not accompany swallows and have a very long time, up to several minutes. It is long term relaxation, allowing more prone to reflux. Transient LES relaxation in patients with GERD is the dilation of the foods most commonly used in the stomach after meals. The transient LES relaxation also occurs in the individual without GERD, but is rare. (6, 7)

Recently described alterations in patients with GERD are the LES relaxation. Specifically, similar expanding pressures open the LES more in patients with GERD than in individuals without GERD. At least in theory, allow easier to open the LES and / or backwards in the acid flow esophagus when the LES is open. (6, 7)

Esophageal contractions

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As mentioned above, the swallows are important for removing the acid in esophagus. Ingestion is caused by the ring like esophageal muscle contraction, reducing the esophageal lumen (cavity). Is called peristalsis, the contraction began in the upper esophagus and transfer to lower esophagus. It propels food, saliva, and whatever else is in the esophagus into the stomach. (6, 7)

When the wave of the contraction is defective there is no acid reflux back into the stomach. In patients with GERD, abnormal contraction described. For example, waves of contraction may not start after every swallow or contraction wave may die before reaching the stomach. (6, 7)Moreover, the shrinkage pressure may be too weak to push back into the stomach acid. Often in patients with GERD have such abnormal contractions that reducing clearance of the esophagus to remove the acid back to stomach. In fact, they found more often in the most serious of patients with GERD. Abnormal contraction of the esophagus will be at night, gravity doesn't help to return refluxed acid to the stomach. Please note that smoking was also significantly reduced from the esophagus to remove the acid. This effect lasted at least six hours after the last cigarette. (6, 7)

Emptying of the stomach

During the daytime, most reflux occurs after a meal. Reflux may be due to relaxation transient LES caused by dilation of the stomach of food. Minority, about 20%, and patients with GERD has been found to have unusually slowly to empty the stomach after a meal.(6) Slower emptying of the stomach prolongs the distention of the stomach with food after meals. So, slow emptying, prolonged period of time during which a return is more likely to occur. (6)

Symptoms of Barrett's esophagus in Esophageal reflux disease

Barrett's esophagus causes no symptoms unique. Gastroesophageal reflux symptoms in patients with Barrett's esophagus. However, not all symptoms of GERD Barrett important, some patients detected with little or no symptoms of GERD accident. Main symptoms are

Heartburn (1)

Regurgitation (1)

Nausea (1)

The return flow of ruminants and occasionally can get into the lungs or voice box, known as extraesophageal symptoms of gastroesophageal reflux disease. These symptoms include:

Laryngitis, (3)

Severe chest pain or pressure, especially if it radiates to the arm, neck, or back. (3)

Chronic cough (6)

Frequent bronchitis, (6)

Hoarseness (especially in the morning) (6)

New onset adult asthma, (6)

Sore throats( burning sensation in the back of the throat), (6)

When to see a doctor

If you've had long-term trouble with heartburn and acid reflux, discuss this with your doctor and ask about your risk of Barrett's esophagus.

Seek immediate medical attention if you:

Are passing black, tarry or bloody stools (3)

Are vomiting red blood or blood that looks like coffee grounds (3)

Have chest pain (3)

Have difficulty swallowing (3)

Heartburn

When acid refluxes back into the esophagus in patients who has GERD, nerve fibers in the esophagus are stimulated. This nerve stimulation results, heartburn most commonly used, the pain, the characteristics of GERD. (2, 3, 6, 7, 11) Heartburn is usually described as burning pain in the center of the chest. You can start in the abdomen, or may extend to the neck. However, in some patients, the pain can be strong pressure or the like, instead of combustion. This pain can mimic heart pain (angina). In other patients, pain may spread to the back. (2, 3, 6, 7, 11)

Since acid reflux is most common after a meal, heartburn is more common after a meal. Heartburn is most common when a person is lying, because under the influence of gravity, reflux is more likely to turn acid in the stomach more slowly. Many patients with GERD awakened from sleep by heartburn. (2, 3, 6, 7, 11)

Regurgitation

Reflux is not the occurrence of reflux liquid in the mouth. In most patients GERD, usually only a small amount of liquid that reaches the esophagus, the liquid remains in the lower esophagus. Occasionally in some patients with GERD a large number of liquid sometimes with food are refluxed and reach the upper esophagus. (2, 3, 7, 11)

Esophagus has upper esophageal sphincter (UES). LES is similar to UES in their action, which is very similar to the ring of muscle. In other words, the UES prevents esophageal content is backed up to the throat. (2, 3, 7, 11)When a small amount of liquid or food reflux get through the UES and enter the throat, there may be a bitter taste in the mouth. If a large quantities breach the UES, the patient may suddenly find a mouthful of liquid or food. More importantly, regular or long-term reflux can lead to tooth erosion induced by acid. (2, 3, 7, 11)

Nausea

Nausea is infrequent in GERD. However, in some patients, may be frequent or severe, and can lead to vomiting. In fact, unexplained nausea and / or vomiting in patients with GERD are the first thing to consider one of the conditions. It is unclear why the development of some patients with GERD is heartburn and the development of other, mainly nausea. (2, 3, 7, 11)

Complications of Barrett's esophagus in Esophageal reflux disease

Although, the risk of the esophageal cancer is higher in people with Barrett's esophagus but it is still rare. Less than 1% of people with Barrett's esophagus develop this specific cancer. However, if you have been diagnosed with Barrett's esophagus is important to have a routine examination of the esophagus. The routine examination, the doctor may be the early detection of precancerous lesions and cancer cells before they spread and the onset is relatively easy to treat. (2, 3, 6, 7)

Barrett's esophagus can lead to some type of esophageal cancer (adenocarcinoma). To 0.5% of Barrett's esophagus develop esophageal adenocarcinoma each year. The people who have Barrett's esophagus need to review periodically the esophagus because of the risk of cancer. (2, 3, 6, 7)

Dysplasia

Atypical hyperplasia is a change in the cells lining the esophagus in which the cells actually appear malignant (for example, tumor cells). However, unlike cancer, these cells remain in place; do not invade tissues outside of the lining. (7, 8, 9)Dysplasia there was a series of changes in the cells of Barrett's esophagus progress related to Barrett's cancer. Barrett monitoring patients and endoscopy and biopsy to detect cell changes (dysplasia) or in the worst cases, the cancer is early detected that they can be treated. At present, there is no way to predict in patients with Barrett's esophagus will develop dysplasia. (7, 8, 9)

Esophageal Cancer

Esophageal cancer is a disease found in the tissue of the esophagus. This cancer is more common in men over 65 years of age. (2, 3)

Risk factors for esophageal cancer include gastroesophageal reflux disease, Barrett's esophagus, smoking and drinking. The risk increases with greater use of cigarettes or alcohol. Overweight or obesity is another risk factor. Diet has been associated with rich in vegetables and fruits lower risk of esophageal cancer. (2, 3, 6, 8)

In esophageal cancer is divided into two main types:

Squamous cell carcinoma - This type of cancer begins in the line of esophageal squamous cell. Any part of this cancer can affect the esophagus. (2, 3, 6)

Adenocarcinoma - Cancers that develop in the gland cells are generally in the lower esophagus. Esophageal gland cells are not normally found in the esophagus. When the gland cells are found in the esophagus, is usually due to acid reflux or Barrett's esophagus. (2, 3, 6)

Esophageal cancer is at an early stage, often without symptoms. Dysphagia, weight loss are common symptoms of esophageal cancer. With the development of cancer it narrows the opening of the esophagus & the difficulty of swallowing and / or pain. (2, 3, 6, 8)

Diagnosing processes

• Upper endoscopy (2,3,5,6,7,9)

• Biopsy (2,3,5,6,7,9)

Perform endoscopy; the doctor called a gastroenterologist inserts a long flexible tube with a camera linked down the throat into the esophagus after giving the patient a sedative. This may feel a little uncomfortable but not painful. Most people with little or no problem.

Once the tube is inserted, the doctor can visually examine the lining of the esophagus. Barrett's esophagus, if any, is visible to the camera, but the diagnosis requires a biopsy.

Doctors will be a small sample of tissue removed in the laboratory to confirm the diagnosis microscope. (2, 3, 5, 6, 7, 9)

The samples were checked for the presence of precancerous or cancer cells. If the biopsy confirmed the presence of Barrett's esophagus, your doctor may recommend follow-up endoscopy and biopsy examination of more organizations of the early signs of cancer.

If you have Barrett's esophagus, but found no cancer or precancerous cells, the doctor may recommend repeating endoscopy periodically. This is a precaution because cancer can happen in Barrett tissue years after diagnosing Barrett's esophagus. If precancerous cells are found in the biopsy, your doctor will discuss treatment options with you. (2, 3, 5, 6, 7, 9)

Determining the degree of tissue changes

It specializes in organizing the laboratory (pathologist); a doctor will examine your esophagus biopsy specimens under a microscope. The pathologist was decided in the degree of cellular changes (hyperplasia). (3)

Grade dysplasia is:

No Dysplasia - If no change in cells, a pathologist to determine the no dysplasia. (3)

Low-grade dysplasia - Cells with low-grade dysplasia may appear small signs of change. (3)

High-grade dysplasia - Cells from high-grade dysplasia show many changes. High grade dysplasia is considered the cells to change the last step before esophageal cancer. (3)

You can detect the type of dysplasia to determine your treatment options in the tissues of the esophagus. (3)

Treatments for Barrett's esophagus in Esophageal reflux disease

One of the main goals of treatment is to prevent or slow the development of Barrett's esophagus by treating and controlling acid reflux. This is through lifestyle changes and medications. Dietary changes, including measures such as:

Avoid alcohol, caffeinated drinks, and tobacco. (2,3,6)

Don't lie down for 3 hours after eating. (2,3,6)

Loss weight. Being overweight increases your risk for reflux. (2,3,6)

Make changes in your diet. Fatty foods, chocolate, caffeine, spicy foods, and peppermint can aggravate reflux. (2,3,6)

Sleep with the head of the bed elevated. Sleeping with your head raised may help prevent the acid in your stomach from flowing up into the esophagus. (2,3,6)

Take all medicines with plenty of water. (2,3,6)

The doctor may also prescribe medications to help. Those medications may include:

Antacids to neutralize stomach acid. (2,3,6)

Promotility agents - drugs that speed up the movement of food from the stomach to the intestines.(2,3,6)

Proton pump inhibitors that reduce the production of stomach acid. Aciphex, Nexium, Prevacid, Prilosec, Protonix, and Zegerid are the mainstay of treatment. (2,3,6)

If these medications do not work, you may need surgery to tighten the sphincter between esophagus and stomach. The physician may remove or using laser treatment, the destruction of normal tissue. These procedures are usually reserved for patients at high risk of developing esophageal cancer. (2, 3, 6)

There are several treatments, including surgery, which is designed for the concentration of abnormal tissue:

Endoscopic mucosal resection (EMR) cites the abnormal epithelium and cut the wall of the esophagus before it is removed through the endoscope. Our goal is to eliminate all lining cells precancerous lesions or cancer. If cancer is present, ultrasound is the first to make sure the cancer is not transferred to the depth of the esophageal wall. (2,3)

Photodynamic therapy (PDT) with a laser that is Inserted into the esophagus and endoscopic destroy abnormal cells in the lining of the esophagus without harming normal tissues. Before to the surgery, patients need the drug photoprin, causing the cells to become sensitive to light. (2,3)

Surgical removal of the esophagus is a serious option for precancerous (dysplasia) or cancer has been confirmed. Early surgery is completed, the diagnosis and service of the opportunity to cure. (2,3)

Surgical treatment

Gastroesophageal reflux disease, the presence of Barrett's esophagi with or without, sometimes it is anti-reflux surgery. Complete this operation that is called fundoflication to stop acid reflux. Fundoplication isn't done for the Barrett's esophagus itself. The surgery involves wrapping the upper stomach (the fundus) around the lower end of the esophagus. The package aims to strengthen the lower esophageal sphincter (LES), in order to prevent the stomach contents reflux into the esophagus. No evidence of anti-reflux surgery, or for that matter, acid suppression medication, reduces the risk of cancer among patients with Barrett's esophagus. This does not mean that the possibility to exclude, but also need long-term studies to prove that if the medical or surgical treatment to reduce the risk of cancer, for example, a study is impossible to do.(2,3,6,7)

The Candidates for the fundoplication operation are patients with gastroesophageal reflux disease who:

Require high doses of acid-suppressing drugs to stop taking these medications. (6)

There are serious complications such as recurrent stenosis. (6)

Today, this surgery is usually performed laparoscopically without a large incision. Therefore, patients have a shorter recovery time, and may be discharged within a few days. In some patients, due to technical reasons lascropic surgery is not possible with traditional open surgery is necessary. (2, 3, 6, 7)

A number of new endoscopic approaches are being evaluated to replace surgery (fundoplication) for the treatment of gastroesophageal reflux disease. The idea is that the endoscope to tighten the junction between stomach and esophagus to prevent the reflux. The restriction is done by the upper gastrointestinal endoscopy Up to five years of data show that these technologies are as effective as fundoplication, but must be considered experimental. . (2, 3, 6, 7)

It is important to note several facts

GERD is common among U.S. adults. (9,10)

Less than 1% of patients with Barrett's esophagus develop esophageal cancer. (9,10)

Only a small percentage of people with GERD (one in 10) develop Barrett's esophagus. (9,10)

A diagnosis of Barrett's esophagus does not cause significant alarm. Barrett's esophagus is, however, considered a precancerous condition. So the diagnosis is a reason to work with your doctor to be attentive to their health. (9, 10)