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Barrett’s
esophagus and Barrett’s esophageal adenocarcinoma are rare diseases with an
increasing incidence in Japan. Barrett’s mucosa is columnar epithelium that
spreads continuously from the stomach to the esophagus. The definition of
Barrett’s mucosa differs between western countries and Japan. This study was
based on the definition established in Japan (i.e., the lower end of
longitudinal vessels which can be observed through endoscopic examination). In
addition, the definition of pathological diagnosis differs between Japan and
western countries, excluding the United Kingdom. In western countries, a biopsy
is required for the diagnosis of Barrett’s mucosa and it is necessary to
determine the presence of intestinal metaplasia. However, in Japan and the United
Kingdom, the diagnosis of Barrett’s esophagus is based on the presence of a
metaplastic columnar-lined esophagus. Mucosal injury, induced by esophagitis
and the repair process, is responsible for the replacement of esophageal
squamous epithelium by columnar epithelium. Gastric acid, the involvement of
duodenal fluid and/or bile acid reflux are causes of esophageal mucosal injury.
Jianwen Que et al. reviewed the mechanism involved in the replacement of the
squamous epithelium by columnar epithelium: 1) reflux-induced
transdifferentiation or transcommitment to produce columnar cells from the
basal layer; 2) extension from the proper esophageal glands and conduit; 3)
extension mucosa from the gastric cardiac glands; 4) circulating bone marrow
cells for progenitor cells; and 5) transdifferentiation from residual embryonic
cells. We reported that the presence of metaplastic epithelium with intestinal
metaplasia is an indicator of a premalignant lesion of esophageal
adenocarcinoma. The clinical guidelines suggest endoscopic surveillance for the
diagnosis of esophageal adenocarcinoma among high-risk populations. Recently,
several studies showed that cytopathology and MUC2 immunohistochemical staining
are useful methods for the screening of intestinal metaplasia, dysplasia and
adenocarcinoma. In this presentation, I discuss the characteristics and
treatment of adenocarcinoma associated with Barrett’s esophagus, including
recent evidence from basic and clinical research.
Keywords: Barrett’s esophagus, Adenocarcinoma,
Characteristics, Diagnosis, Treatment
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