Barrett's Esophagus Definition and Pathophysiology
📌 Barrett's esophagus involves abnormal change (metaplasia) in the lower esophagus, where the normal stratified squamous epithelium is replaced by simple columnar epithelium with goblet cells.
🤢 It is a serious complication of chronic GERD (Gastroesophageal Reflux Disease), developing in about 10% of people with chronic GERD symptoms.
🔬 This cellular change is specifically characterized as intestinal metaplasia, meaning cells typically found in the intestine line the lower esophagus near the gastroesophageal Junction.

Epidemiology and Symptoms
📊 Incidence in the U.S. among Caucasian men is 8 times that of Caucasian women and 5 times that of African-American men; the overall male-to-female ratio is 10:1.
🌍 Prevalence estimates vary globally, ranging from 1.3% to 1.6% in European populations to 3.6% in a Korean population.
⚠️ Barrett's esophagus itself has no specific symptoms, but patients typically present with symptoms related to chronic GERD, such as frequent heartburn, dysphagia (trouble swallowing), hematemesis (vomiting blood), and unintentional weight loss (aphagia).

Diagnosis and Disease Progression
✅ Diagnosis requires both macroscopic (visual) and microscopic (biopsy) confirmation via an upper GI endoscopy, identifying columnar epithelium replacing the normal squamous lining.
📈 The disease follows a progression: Normal lining $\rightarrow$ Barrett's cells $\rightarrow$ Low-grade dysplasia $\rightarrow$ High-grade dysplasia $\rightarrow$ Invasive carcinoma (adenocarcinoma).
👨‍⚕️ Screening endoscopy is recommended for males over 60 with long-duration, uncontrolled chronic reflux symptoms.

Treatment Strategies
⚕️ Primary treatment focuses on controlling acid reflux through lifestyle changes (avoiding fatty foods, caffeine, alcohol; weight loss) and medications like Proton Pump Inhibitors (PPIs).
🔪 Specific treatments target abnormal tissue, including Radiofrequency Ablation (RFA) using radio waves to destroy abnormal cells while sparing healthy tissue.
🧊 Other targeted procedures include Photodynamic Therapy (PDT), Endoscopic Spray Cryotherapy (using frozen gas), and Endoscopic Mucosal Resection (EMR) to remove lifted abnormal lining.
🔪 In severe cases involving high-grade dysplasia or cancer, an esophagectomy (surgical removal of most of the esophagus) may be necessary, with earlier surgery offering a better chance for a cure.

Key Points & Insights
➡️ Barrett's esophagus represents a cellular transformation from squamous to columnar epithelium due to chronic acid exposure from GERD.
➡️ Diagnosis relies on endoscopy and biopsy to confirm metaplasia and screen for precancerous cells (dysplasia).
➡️ Treatment involves two tiers: managing GERD (with lifestyle changes and PPIs) and ablating abnormal tissue using methods like RFA or PDT.
➡️ Early diagnosis and intervention are critical, especially when high-grade dysplasia is detected, to prevent progression to invasive adenocarcinoma.

📸 Video summarized with SummaryTube.com on Nov 29, 2025, 16:36 UTC