Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Barrett's esophagus has no unique symptoms. Patients with Barrett's have the
symptoms of GERD (for example, heartburn, regurgitation, nausea, etc.). The
general trend is for individuals with Barrett's have more severe GERD. However, not
all Barrett's have marked symptoms of GERD, and some patients are detected
accidentally with minimal or no symptoms of GERD.
Heartburn is a burning sensation behind the breastbone, usually in the lower
half, but may extend all the way up to the throat. Sometimes, it is accompanied
by burning or pain in the pit of the stomach just below where the breastbone
ends.
Regurgitation (backup) of bitter tasting
fluid is another common symptom.
The refluxed, regurgitated fluid occasionally may enter the lungs or the
voice box, resulting in what are called extraesophageal symptoms of GERD. These symptoms include:
Barrett's esophagus is a
complication of chronic gastroesophageal reflux disease (GERD), primarily in
white men. GERD is a disease in which there is reflux of acidic fluid from the
stomach into the esophagus (the swallowing tube). It most commonly causes heartburn.
There
are two requirements for the diagnosis of Barrett's esophagus. The requirements necessitate an endoscopy of the esophagus. During endoscopy, a long flexible tube with a light and camera at its tip (an endoscope) is inserted
through the mouth and into the esophagus to view and biopsy (sample tissue from) the lining of the esophagus. The two requirements are:
At endoscopy, an abnormal pink lining should be seen as replacing the normal whitish lining of the esophagus. This abnormal lining extends a short distance (usually less than 2.5 inches) up the esophagus from the gastroesophageal junction (the GE junction, which is where the esophagus joins the stomach).
Microscopic evaluation of the biopsy of this abnormal lining should shows that the normal lining cells of the esophagus have been replaced by intestinal type lining cells, including mucus-producing cells called goblet cells. Other cells also are present, some of which resemble cells that line the stomach. However, if intestinal goblet cells are not present, the diagnosis of Barrett's esophagus should not be made.
Barrett's esophagus is officially coded by the Library
of Congress for electronic searches of the literature as Barrett esophagus, but
Barrett's esophagus (with the apostrophe "s") is the name used universally. The
condition is named after a surgeon, Norman Barrett, who described the condition. However, it turns out that his interpretation of the findings was not correct. In 1953, Doctors' Allison and Johnstone actually described this condition as we now understand it, namely that metaplasia was occurring. (Metaplasia, which is discussed below, is the term used when one adult tissue replaces another.) Nevertheless, the condition has been immortalized with Barrett's name.
Initially, it was thought that the Barrett's esophagus consisted of stomach (gastric) tissue replacing the usual squamous tissue lining the esophagus. However, in the mid 70's, Dr. Paull and colleagues published a paper in which they described the mucosa (inner lining) of Barrett's esophagus in greater detail than had been done previously. They pointed out that Barrett's esophagus consisted of a metaplasia in which the normal cells lining the esophagus were replaced by a mixture of gastric and intestinal lining cells. The intestinal-type lining cells also are called specialized columnar cells which include goblet cells. For a number of years, some scientists thought that there were two types of Barrett's; one in which the normal lining was replaced with stomach (gastric) type cells only, and the second in which intestinal cells were present. However, the current belief is that only the presence of intestinal-type goblet cells establishes the diagnosis of Barrett's esophagus, regardless of what other cell types are present.
Why is there so much interest in Barrett's esophagus?
The reason for the great interest in Barrett's esophagus
is that it is associated with an increased risk of
cancer of the esophagus. The type of cancer that occurs in patients with Barrett's is adenocarcinoma, which
arises from the metaplastic intestinal tissue. The usual cancer of the esophagus
that is not associated with Barrett's is squamous carcinoma, which arises from
the squamous cells lining that is normally present in the esophagus. The connection between adenocarcinoma of the esophagus and Barrett's esophagus is now clear, and adenocarcinoma of the esophagus is increasing in frequency in most countries in the Western hemisphere.
The good news, however, is that the cancer occurs in
relatively few patients with Barrett's esophagus. Still, the main challenge in
this condition is to watch for early warning signs of cancer by taking biopsies
at regular intervals during endoscopy. This practice is called surveillance and
is similar, in principle, to the surveillance in women for
cancer of the cervix,
wherein PAP smears are taken at regular intervals.
Most sore throats are caused by viruses or mechanical causes (such as mouth breathing) and can be treated successfully at home. However, a person should be seen by a health care professional if they have a sore throat that has a rapid onset, and is associated with a fever or tenderness of the front of the neck; a sore throat that causes the person to have difficulty swallowing (not just pain swallowing) or breathing; or if a sore throat lasts for more than a week.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Bronchitis is a disease of the respiratory system in which the bronchial passages become inflamed. There are two types of bronchitis, acute and chronic. Symptoms of acute bronchitis include frequent cough with mucus, lack of energy, wheezing, and possible fever. Treatment may require medication such as bronchial inhalers and predinsone. Supportive treatment is focused on relieving the symptoms with fever reducers, cough suppressants, and rest. Treatment may be more aggressive in patients with pre-existing conditions such as empyema, COPD, or cigarette smoking.
A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. Causes of hiatal hernia are a larger than normal esophageal hiatus. There are two types of hiatal hernias, sliding, or para-esophageal. When symptoms of hiatal hernia appear, they are similar to GERD symptoms. Hiatal hernia treatment is generally surgery.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
Esophageal cancer is a disease in which malignant cells form in the esophagus. Risk factors of cancer of the esophagus include smoking, heavy alcohol use, Barrett's esophagus, being male and being over age 60. Severe weight loss, vomiting, hoarseness, coughing up blood, painful swallowing, and pain in the throat or back are symptoms. Treatment depends upon the size, location and staging of the cancer and the health of the patient.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation (gastritis) of the inner lining of the stomach in humans. This bacteria also is the most common cause of ulcers worldwide.
Eosinophilic esophagitis is an inflammation of the esophagus. Eosinophilic esophagitis has many causes including acid reflux, heartburn, viruses, medications that become stuck in the esophagus, allergy, asthma, hay fever, allergic rhinitis, and atopic dermatitis. Eosinophilic esophagitis symptoms include difficulty swallowing food, abdominal pain, chest pain, and heartburn.
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Gastritis is an inflammation of the stomach lining. Causes of gastritis include drinking too much alcohol, medications such as NSAIDs, ibuprofen, aspirin, H. pylori infection, severe infections, burns, anemia, and autoimmune disorders. Gastritis is diagnosed with endoscopy, blood tests, or stool tests. Treatment depends upon the cause of gastritis.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Hoarseness (abnormal deep, harsh, raspy voice) is caused by a variety of conditions in which the larynx (voice box and vocal chords) are irritated or injured. Examples of causes of hoarseness include: laryngitis, straining the vocal cords by yelling or screaming, infections, GERD, allergies, and more. Treatment of hoarseness depends on the cause.
Schatzki (Schatzki's) ring, is a narrow ring of tissue located just above the junction of the esophagus and stomach. The cause of Schatzki ring is not clearly known, however, some doctors believe they are caused by long term acid reflux. The symptoms of a Schatzki ring is primarily poorly chewed food that stays in chunks becoming stuck in the esophagus. Diagnosis of Schatzki's ring is barium x-ray or endoscopy. Treatment is generally a procedure to stretch or fracture the rings.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Heartburn is a burning sensation experienced from acid reflux (GERD). Symptoms of heartburn include chest pain, burning in the throat, difficulty swallowing, the feeling of food sticking in the throat, and a burning feeling in the chest. Causes of heartburn include dietary habits, lifestyle habits, and medical causes. Treatments for heartburn include lifestyle changes, OTC medication, prescription medication, and surgery.
Acid backing up into the larynx (voice box), it causes reflux laryngitis. Irritation of the lining of the esophagus, larynx, and throat can lead to esophagitis, sinusitis, strictures, hoarseness, throat clearing, swallowing problems, asthma, chronic cough, and more. Typical symptoms of reflux laryngitis include heartburn, hoarseness, or a sensation of a foreign body in the throat. Reflux laryngitis can be treated with OTC medication, prescription medication, and lifestyle changes.
Disease prevention in men includes routine screening tests that are part of basic prevention medicine. Take an active role in your own health care and discuss screening tests with your doctor early in life. Age of screening and timing of screening depends upon the condition being assessed.
Stool
(feces) is most commonly brown in color, and many people become curious or
concerned when the color of their stool changes. Most stool-to-stool changes in
color have little meaning; however, some changes, particularly if the changes
are consistent from stool-to-stool and not present in only one stool, can be
important.
What causes normal stool color?
The color of stool is normally due to the presence of bile, specifically, the
bilirubin in bile. Bilirubin is formed from
hemoglobin after hemoglobin is
released from red blood cells during their destruction, a part of the normal
process of replacing the red blood cells in blood. The released hemoglobin is
modified chemically and removed from the blood by the
liver. In the liver the
chemically changed hemoglobin (called bilirubin) is attached to other chemicals
and secreted from the cells of the liver into bile. Depending on the
conc...
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