Mechanisms of Barrett's oesophagus (clinical): LOS dysfunction, hiatal hernia, peristaltic defects

Best Practice & Research. Clinical Gastroenterology
Sabine Roman, Peter J Kahrilas

Abstract

Barrett's oesophagus, with the potential to develop into oesophageal adenocarcinoma (OAC), is a major complication of gastrooesophageal reflux disease (GORD). However, about 50% of patients developing OAC had no known GORD beforehand. Hence, while GORD symptoms, oesophagitis, and Barrett's have a number of common determinants (oesophagogastric junction (OGJ) incompetence, impaired oesophageal clearance mechanisms, hiatus hernia) they also have some independent determinants. Further, although excess oesophageal acid exposure plays a major role in the genesis of long-segment Barrett's oesophagus there is minimal evidence supporting this for short-segment Barrett's. Hence, these may have unique pathophysiological features as well. Long-segment Barrett's seems to share most, if not all, of the risk factors for oesophagitis, particularly high-grade oesophagitis. However, it is uncertain if OGJ function and acid clearance are more severely impaired in patients with long-segment Barrett's compared to patients with high-grade oesophagitis. With respect to short-segment Barrett's, the acid pocket may play an important pathogenic role. Conceptually, extension of the acid pocket into the distal oesophagus, also known as intra-sphincteric ...Continue Reading

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Citations

Oct 11, 2017·ANZ Journal of Surgery·Syeda Khadijah AhmedDavid I Watson
May 20, 2017·Current Medicinal Chemistry·Teodora Surdea-BlagaDan L Dumitrascu
Apr 24, 2020·Journal of Clinical Gastroenterology·Ronnie FassFahmi Shibli
Dec 12, 2020·BMJ Case Reports·Navin Mukundu NageshDavid Khoo

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