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Barrett Esophagus

Barrett Esophagus. General concept. Risk factors: hiatal hernia, duodenogastric reflux ,delayed acid clearance time, ↓LESp Adult disorder → 376 per 100000 Irreversible condition M/F = 2/1. Definition. Specialized columnar epithelium with goblet cells (positive for Alcian blue in pH:2.5)

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Barrett Esophagus

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  1. Barrett Esophagus

  2. General concept • Risk factors: hiatal hernia, duodenogastric • reflux ,delayed acid clearance time, ↓LESp • Adult disorder → 376 per 100000 • Irreversible condition • M/F = 2/1

  3. Definition • Specialized columnar epithelium with goblet cells (positive for Alcian blue in pH:2.5) • Absence of goblet cells is insufficient to make a definitive diagnosis • “Barrett cytokeratin 7/20 pattern”

  4. Dysplasia in Barrett Esophagus • Negative for dysplasia • Indefinite for dysplasia • Low grade dysplasia • High grade dysplasia

  5. Grading algorithm • Surface maturation (low power) • Architecture (low power) • Cytologic features • Inflammation and erosions/ulcers

  6. Barrett esophagus, negative for dysplasia • Surface epithelium more mature than underlying glands • Normal architecture • Nuclear stratification - ↑N/C, small nucleoli, mitoses are normal in Deeper glands • Nuclear polarity and, smooth outlines are preserved in Deep and superficial

  7. Barrett esophagus, indefinite for dysplasia • Nuclear membrane irregularity, hyperchromasia in Deep, • with normal maturation to surface • Active PMN infiltration • No polarity disturbance • No architectural abnormality

  8. Barrett esophagus, low grade dysplasia • Extension of cytological abnormalities to surface (at least focally) • No maturation to surface • Abundant inflammation, prominent nucleoli, abnormal architectures and loss of polarity are not LGD features.

  9. Barrett esophagus, high grade dysplasia • Prominent cytologic abnormalities • Markedly distorted glands • Little intervening lamina propria

  10. Surrogate Biomarkers • DNA content (flowcytometry) • P53 → progression

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