Ali YEĞİNSU, Reşit Doğan KÖSEOĞLU, Makbule ERGİN, Cumhur İbrahim BAŞSORGUN

Barrett özofagusu

Barrett özofagusu, distal özofagustaki normal skuamöz epitelin yerine intestinal metaplazi içeren anormal kolumnar mukozanın geçtiği bir durum olarak tanımlanır. Ülkemizde gastroözofajiyal reflü prevalansı %20, Barrett özofagusu prevalansı %0.4’tür. Gastroözofajiyal reflüye bağlı kronik mukoza irritasyonu Barrett özofagusu gelişiminin en önemli nedenidir. Bununla birlikte obezite ve diğer bazı hastalıklar da Barrett özofagusu gelişimine neden olabilir. Barrett özofagusu özofajiyal adenokarsinomun bilinen tek öncü lezyonudur ve görülme sıklığı günümüzde en hızlı artan kanser türlerinden biridir. Karsinojenik risk normal nüfusa oranla 30 kat daha fazladır. Tedavide, reflü semptomlarının giderilmesi, asit ve duodenal içeriğin özofagusa reflüsünün engellenmesi, erozyon, peptic ülser ve striktür gibi komplikasyonların önlenmesi, intestinal metaplazinin proksimale ilerlemesinin durdurulması, intestinal metaplazinin normal mukozaya gerilemesinin hızlandırılması, displaziye gidişin durdurulması, displazinin nondisplastik hücrelere gerilemesinin hızlandırılması ve adenokarsinoma gidişin durdurulması amaçlanmalıdır. Barrett özofagusunda seçilecek tedavi yöntemini displazinin derecesi belirler. Displazisiz ve düşük displazili hastalarda takip, medikal tedavi, antireflü cerrahisi ya da ablasyon tedavileri yeterli olabilirken, yüksek dereceli displazilerde özofajektomi tercih edilmelidir.

Barrett’s esophagus

Barrett esophagus is described as a condition in which the normal squamous epithelium of the distal esophagus is replaced by abnormal columnar mucosa containing intestinal metaplasia. The prevalence of gastroesophageal reflux is 20% and Barrett esophagus is 0.4% in Turkey. Cronic mucosa irritation related to gastroesophageal reflux is the most important cause of the development of Barrett esophagus. In addition, obesity and some other diseases may result in Barrett esophagus development. Barrett esophagus is the only known precursor to esophageal adenocarcinoma and to date, it is one of the cancer types that has the most rapidly increasing incidence. Carcinogenic risk is 30 times higher than that in the normal population. Treatment should have the purpose of controlling symptoms of gastroesophageal reflux, preventing acid and duodenal reflux into esophagus, preventing the development of complications, such as erosion, peptic ulcus, stricture, preventing proximally extension of intestinal metaplasia, inducing regression of intestinal metaplasia to the normal mucosa, preventing the development of dysplasia, inducing regression of dysplasia to nondysplastic cells, and preventing the development of adenocarcinoma. The grade of the dysplasia determines the treatment modality. Whereas in patients with non-dysplastic or low grade dysplasia, followup, medical treatment, antireflux surgery or ablation therapy may be appropriate, esophagectomy should be preferred in patients with high grade dysplasia.

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