Barrett's syndrome – the gullet pathology which is characterized by a gastric metaplaziya of an epithelium, caused by a chronic gastroezofagealny reflux and impact of hydrochloric acid on a mucous membrane. Is a precancer state. The reflux-ezofagita is clinically shown by an eructation, heartburn, pain behind a breast and signs. The gold standard of diagnostics consider an ezofagogastroskopiya with a biopsy, in addition appoint a hromoskopiya, a manometriya and a rn-metriya of a gullet, a contrast radiological research (ezofagografiya). Treatment conservative (antisekretorny and antatsidny medicines, pro-kinetics), at the complicated current - surgical.
Barrett's syndrome, Barrett's gullet, also known under the name, – the serious illness arising owing to long regular impact of sour gastric juice on proximal departments of a gullet at a gastroezofagealny reflux disease. The main danger of this pathology is connected with frequent development of an adenocarcinoma of a gullet against the background of a metaplaziya of an ezofagealny epithelium. For the first time the metaplastic epithelium of a gullet was described by Barret in 1950, however was considered by the author as norm option (stomach shift in a chest cavity at congenital shortening of a gullet). Seven years of researches in gastroenterology were necessary for Barrett for establishment of that fact that the metaplazirovanny epithelium containing scyphoid cages is a pathological precancer state.
Today it is known that Barrett's gullet develops, according to different data, at 1-80% of patients about GERB, and incidence has direct dependence on age and duration of the reflux anamnesis. Most often the disease arises aged from 45 up to 65 years, men are ill two-five times more often than women; at a malignization of a gullet of Barrett a ratio of men and women 9:1.
Reasons of a syndrome of Barrett
The main etiologichesky factor of a syndrome of Barrett is GERB. At this disease there is a continuous throwing of sour gastric contents in the lower departments of a gullet that as a result leads to damage of an ezofagealny epithelium and its metaplaziya. At the same time in a gullet can reveal intestinal, fundalny and kardialny glands. Regeneration of cells of a mucous membrane at patients with the relaxation of a kardialny sphincter raised by acidity of gastric juice, oppression of secretion of a factor of growth of epidermis, failures of proliferation of an epithelium is the most probable. Gullet cancer with Barrett's syndrome occurs at patients practically by 100 times more often than in the general population. A substratum for formation of cancer cells is the metaplaziya of an epithelium of high degree – its formation requires about four years, and for regeneration of metaplazirovanny cages in cancer usually enough 6-20 months.
Most often to emergence of a gullet of Barrett at patients with GERB gives deterioration in conditions of accommodation, smoking and alcohol intake in any quantities, reception of some medicines against the background of a reflux-ezofagita. More than 5 years carry a male, the reflux anamnesis to risk factors, the age is more senior than 50 years, a numerous recurrence a reflux-ezofagita within a year. At hit in a gullet of pancreatic enzymes and bile the disease proceeds heavier, and the metaplaziya progresses quicker. At the initial stages of a syndrome of Barrett migration of a cylindrical gastric epithelium in a gullet is protective reaction since such mucous it is less subject to aggressive influence of acidic environment.
Normal the cylindrical epithelium can migrate out of borders of the Z-line (border between a gullet and a stomach) within 2 cm, and here detection of a metaplaziya the proksimalny 2,5 cm from a kardialny sphincter after several biopsies allow to state presence at the patient of a syndrome of Barrett.
Symptoms of a gullet of Barrett
Complexity of diagnostics of a syndrome of Barrett is that his clinical signs are completely caused by a gastroezofagealny reflux disease, and is possible to reveal a disease only after an epithelium biopsy. The most frequent complaint (it three quarters of patients show) is the heartburn arising because of long impact of acidic environment of a stomach on a mucous membrane of a gullet. Heartburn disturbs after food, physical activities, trunk inclinations more often. The similar pathogenesis has also emergence of an eructation acid, bile or air. Regurgitation of food masses from a stomach develops in a mouth because of the expressed relaxation of a kardialny sphincter which is not capable to hold contents in a stomach cavity more.
Much less often the dysphagy can disturb the patient: usually it develops at the expressed metaplaziya, and its strengthening which is followed by vomiting and bleedings can indicate existence of an adenocarcinoma of a gullet. Barrett's syndrome is often connected with the phenomena of an erosive ezofagit to whom chronic bleedings, anemia, an iskhudaniye accompany. Besides, such symptoms as a dysphagy, bleedings, anemia and a kakheksiya usually indicate gullet cancer.
Diagnostics of a syndrome of Barrett
At emergence of the first signs of GERB it is necessary to address the gastroenterologist. The reflux-ezofagita is the gold standard of diagnostics an ezofagogastroskopiya with an endoscopic biopsy of the centers of the changed epithelium. During an ezofagoskopiya metaplazirovanny sites of a mucous membrane are visualized in the form of the languages of hyperaemia extending from the Z-line in the proximal direction more than to 2,5 centimeters. For exact diagnostics it is necessary to carry out a biopsy from four pathological sites, to carry out a hromoskopiya of a gullet and stomach. For differentiation of pathology and identification of complications also carry out a gullet X-ray analysis, a gastrokardiomonitoring, a GIT impedansometriya, an ezofagealny manometriya, an intra esophageal rn-metriya. The analysis the calla on the hidden blood allows to reveal internal bleeding from the top departments of a digestive tube.
The morphological research of bioptat at Barrett's syndrome usually reveals elements of a gastric epithelium in a mucous membrane of a gullet (cylindrical epitelialny cages, fundalny, kardialny and intestinal glands). Considering hereditary predisposition to Barrett's syndrome and an adenocarcinoma of a gullet, the research of level of markers of a dysplasia of a gullet in blood is recommended.
Lack of signs of a metaplaziya of an epithelium in bioptata does not allow to exclude Barrett's syndrome at the patient. Quite often the biopsy of affected areas of a mucous membrane is complicated by the strengthened gullet vermicular movement, a reflux of gastric contents, a melkoochagovy and scattered arrangement of pathological zones. To such patients recommend to hold dynamic consultations of the endoscopist with repeated biopsies of a gullet.
Treatment of a syndrome of Barrett
Today the optimum methods of treatment of a syndrome of Barrett allowing to achieve full regress of clinical manifestations and histologic changes are in a development stage.
Therapeutic tactics at Barrett's syndrome depends on a stage of a disease and expressiveness of symptoms. At an easy and moderate metaplaziya of an epithelium treatment consists in elimination of clinical manifestations of a gastroezofagealny reflux, restoration of a normal epitelialny cover of a gullet, the prevention of malignant regeneration.
For treatment of GERB use non-drug means and medicines. Refer normalization of a day regimen and food, treatment of obesity, a dream in a semi-sitting position to non-drug methods of influence, refusal of addictions, hard belts, excess physical activities.
Medicamentous therapy includes antisekretorny medicines (blockers of a proton pomp, at their intolerance – blockers of H2-histamine receptors); antatsida; pro-kinetics (, ). The greatest effect of drug treatment is reached at a combination of three of these groups of medicines. If the throwing of bile in a gullet is noted, appoint ursodezoksikholevy acid. In the presence of complaints to feeling of a raspiraniye and overflow of a stomach after food the fermental medicines which are not containing bilious acids in the structure are applied.
Researches in the field of gastroenterology show that at patients, it is long receiving antisekretorny and antatsidny medicines before detection of this disease, the segment of a gullet of Barrett is much shorter, and the level of a metaplaziya is reliable below, than at the patients who were not using the specified medicines.
Indications to expeditious treatment of a syndrome of Barrett consider gullet striktura, high degree of a metaplaziya, an ulcer of a gullet, resistant to therapy, bleedings from a gullet, high risk of a malignization. Endoscopic techniques are applied to destruction of a metaplazirovanny epithelium: photodynamic, laser, plasma argonny therapy; electrothermic coagulation and cryodestruction; endoscopic resection of a mucous membrane of a gullet.
Forecast and prevention of a syndrome of Barrett
The forecast at identification of a syndrome of Barrett adverse. With a long segment of a metaplazirovanny gullet ezofagealny cancer is diagnosed for patients in 0,5-1% of cases, at a short segment of a metaplaziya the frequency of a malignization is much lower. At a short segment of a syndrome of Barrett and low degree of a metaplaziya full regress of an endoscopic picture against the background of conservative treatment at 8% of patients is possible. Carrying out anti-reflux operation leads to recovery approximately at 4% of patients.
It is possible to prevent development of a syndrome of Barrett only by timely diagnosis and treatment of a gastroezofagealny reflux disease. Specific prevention of a gullet of Barrett is not developed. Patients with Barrett's syndrome, even after effective conservative and surgical treatment, demand annual endoscopic inspection with an epithelium biopsy.