At present, there is no uniform treatment for Barrett’s esophagus at home and abroad, and its cancer rate is 5%, which is quite worrying for patients as a pre-cancerous lesion of esophagus. However, the disease can be reversed through personalized treatment, and the case cure report is presented here.
Patient, female, 54 years old. On 2009-12-9, gastroscopy at the local hospital showed an orange-red island of erosion in the mucosa above the dentate line at the lower end of the esophagus. The cardia was well closed. The fundus and angle of the stomach were normal in shape. The mucosa of the gastric sinus was smooth with normal peristalsis, and the pylorus was round and opened and closed freely. The mucosa of the duodenal bulb was smooth and no erosion or ulceration was seen. Diagnosis: Barrett’s esophagus. One esophageal mucosal biopsy, pathological diagnosis: chronic inflammatory esophageal mucosal tissue. Ren Hongyu, Department of Gastroenterology, Wuhan Union Medical College Hospital
After 3 months of medication, gastroscopy was repeated on 2010-1-15: esophageal mucosa was smooth with clear vascular texture, an orange-red island mucosa was seen above the dentate line; cardia was well closed, gastric fundus, gastric body, gastric angle, gastric sinus mucosa was smooth, and peristalsis was normal. The pylorus was round in shape and opened and closed freely. The mucosa of the duodenal bulb was smooth and no ulcer or erosion was seen. Pathological diagnosis of esophageal mucosa biopsy: consistent with Barrett’s esophagus. Diagnosis: Barrett’s esophagus was considered. The lesion still existed and it was evident that the disease was not so easily cured! So, continued to take medication.
2010-3-19 Third gastroscopy, what was seen endoscopically: two orange-red islands of mucosa were seen above the dentate line of the lower mucosa of the esophagus. No abnormality was seen in the rest of the stomach. The endoscopic diagnosis was: Barrett’s esophagus. In response to the recalcitrant nature of the disease, the physician decided to perform an endoscopic magnified staining of the lesion and to perform an accurate biopsy of the area where the staining showed suspicious epithelial metaplasia. After localization of the magnified staining, the biopsy pathological diagnosis was seen: entericized epithelium. Therefore, the patient was identified for argon electrocautery treatment of Barrett’s esophagus, and after the procedure was completed, the treatment was continued with medication.
2010-5-10 Gastroscopy results: confirmed healing of Barrett’s esophagus. The disease is curable by medication in most patients. In some patients who present with intestinal or gastric epithelial metaplasia, medication is not effective and endoscopic minimally invasive surgical treatment with electrocautery or excision of the diseased mucosa is required to achieve a complete cure of the disease as soon as possible. Even after the disease is cured, it is still necessary to control the diet, eat less spicy, tea and coffee, and eat less sweets to reduce recurrence. Also, it is important to review the gastroscopy regularly, such as once every 3-6 months at first, and then once every 1-2 years when there is no abnormality, to prevent the disease from evolving.
1. Plain gastroscopy shows esophageal island erosion 2. Gastroscopic staining shows the lesion more clearly 3. Magnification of the lesion shows disorder in the opening of the glandular duct
What is Barrett’s esophagus?
Barrett’s esophagus is a pathology in which the squamous epithelium of the lower esophagus is replaced by a single layer of columnar epithelium, first described by Norman Barrett in 1950 and named after him. Barrett’s esophagus is asymptomatic in itself, but the special feature is the epithelial metaplasia of the esophagus, which increases the rate of malignancy in patients, with the incidence of esophageal adenocarcinoma ranging from 5 to 20%, 30 to 125 times higher than in the general population.
Biopsy is required to confirm the diagnosis of Barrett’s esophagus.
The definitive diagnosis of the disease is characterized by pathological changes in the patient’s esophageal histology. In patients with suspected disease, the final diagnosis cannot be made based on plain endoscopic findings alone, but requires a biopsy of the lesion, i.e., a piece of mucosal tissue is clamped at the site of the lesion and observed under a microscope, and a single layer of columnar epithelium is found to confirm the diagnosis (shown). If magnification staining is performed under the endoscope, the staining can be used to show the suspected epithelial metaplasia, and magnification of the mucosa at the lesion site for the presence of glandular duct openings of columnar epithelium for accurate biopsy will help in the diagnosis.