Gå direkt till huvudinnehållet

Barretts esofagus

Senast reviderad:
Sakkunnig:


Definition:
Intestinal metaplasi i distala esofagus.
Förekomst:
Prevalensen var i en svensk studie 1,6 %, varav 40 % var symtomfria.
Symtom:
De flesta har symtom på refluxsjukdom i form av sura uppstötningar, halsbränna och svidande smärtor i epigastriet, men vissa är asymtomatiska.
Kliniska fynd:
Ofta inga kliniska fynd.
Diagnostik:
Endoskopi och biopsi, alternativt PAD från mukosarecesserade slemhinneförändringar, fastställer diagnosen.
Behandling:
Protonpumpshämmare och i vissa fall resektion eller ablation av slemhinna. Kontroller enligt nationella riktlinjer.
  1. Spechler SJ, Souza RF. Barrett's esophagus. N Engl J Med. 2014 Aug 28;371(9):836-45. doi: 10.1056/NEJMra1314704. DOI  
  2. Ronkainen J, Aro P, Storskrubb T, et al. Prevalence of Barrret's esophagus in the general population: an endoscopic study. Gastroenterology 2005; 129: 1825-31. PMID: 16344051 PubMed  
  3. Ward EM, Wolfsen HC, Achem SR, et al. Barreet's esophagus is common in older men and women undergoing screening colonoscopy regardless of reflux-symptoms. Am J Gastroenterol 2006; 101: 12-7. PubMed  
  4. Westhoff B, Brotze S, Weston A, et al. The frequence of Barret's esophagus in high-risk patients with chronic GERD. Gastrointest Endosc 2005; 61: 226-31. PubMed  
  5. Shalauta MD, Saad R. Barrett's esophagus. Am Fam Physician 2004; 69: 2113-20. PubMed  
  6. Cameron AJ, Lomboy CT. Barrett's esophagus: age, prevalence, and extent of columnar epithelium. Gastroenterology 1992; 103: 1241-5. Gastroenterology  
  7. Bonino JA, Sharma P. Barrett's esophagus. Curr Opin Gastroenterol. 2006;22:406-411. PubMed  
  8. Nationella riktlinjer för utredning samt handläggning av Barretts esofagus. Svensk Gastroenterologisk Förening (SGF) Nationella Riktlinjer, 2015 svenskgastroenterologi.se  
  9. de Jonge PJF, van Blankenstein M, Looman CWN, et al. Risk of malignant progression in patients with Barrett's oesophagus: a Dutch nationwide cohort study. Gut 2010; 59: 1030-6. Gut  
  10. Thomas T, Abrams KR, De Caestecker JS, Robinson RJ. Meta analysis: cancer risk in Barrett's oesophagus. Aliment Pharmacol Ther 2007; 26: 1465-77. PubMed  
  11. Spechler SJ. Barrett esophagus and risk of esophageal cancer: a clinical review. JAMA. 2013 Aug 14;310(6):627-36. PMID: 23942681. PubMed  
  12. Bhat S, Coleman HG, Yousef F, et al. Risk of malignant progression in Barret's esophagus patients: results from a large population-based study. J Natl Cancer Inst 2011; 103: 1049-57. PubMed  
  13. Hvid-Jensen F, Pedersen L, Drewes AM, et al. Incidence of adenocarcinoma among patients with Barrett's esophagus. N Engl J Med 2011; 365: 1375-83. New England Journal of Medicine  
  14. Kroep S, Lansdorp-Vogelaar I, Rubenstein JH, et al. An accurate cancer incidence in Barrett's esophagus: A best estimate using published data and modeling. Gastroenterology 2015; 149: 577-85. pmid:25935635 PubMed  
  15. Weston AP, Sharma P, Mathur S, et al. Risk stratification of Barrett's esophagus: updated prospective multivariate analysis. Am J Gastroenterol 2004; 99: 1657-66. PubMed  
  16. Rudolph RE, Vaughan TL, Storer BE, et al. Effect of segment length on risk of neoplastic progression in patients with Barrett esophagus. Ann Intern Med 2000; 132: 612-20. PMID:10766679 PubMed  
  17. Jankowski J, Barr H, Wang K, Delaney B. Diagnosis and managmenet of Barrett's oesophagus. BMJ 2010; 341: c4551. PMID: 30057104 PubMed  
  18. Weston AP, Banerjee SK, Sharma P, Tran TM, Richards R, Cherian R. P53 protein overexpression in low grade dysplasia (LGD) in Barrett's esophagus: immunohistochemical marker predictive of progression. Am J Gastroenterol 2001; 96: 1355-62. PubMed  
  19. Lagergren J, Bergstrom R, Nyren O. Association between body mass and adenocarcinoma of the esophagus and gastric cardia. Ann Intern Med 1999; 130: 883-90. Annals of Internal Medicine  
  20. Shaheen NJ, Richter JE. Barret's oesophagus (Seminar). Lancet 2009; 373: 850-61. PubMed  
  21. Gerson LB, Shetler K, Triadafilopoulos G. Prevalence of Barrett's esophagus in asymptomatic individuals. Gastroenterology 2002;123:461-7. Gastroenterology  
  22. Spechler SJ. A 59-year-old woman with gastroesophageal reflux disease and Barrett esophagus. JAMA 2003; 289: 466-75. Journal of the American Medical Association  
  23. Bennett C, Moayyedi P, Corley DA, et al. BOB CAT: a Large-Scale Review and Delphi Consensus for Management of Barrett's Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia. Am J Gastroenterol. 2015 ;110:662-82; quiz 683. doi: 10.1038/ajg.2015.55 DOI  
  24. National Institute for Health and Clinical Excellence . Dyspepsia: managing dyspepsia in adults in primary care. NICE 2005; Clinical guideline CG17.
  25. Standardiserat vårdförlopp matstrups- och magsäckscancer, kortversion för primärvården. Hämtad 2019-07-10. www.cancercentrum.se  
  26. de Jonge PJ, Spaander MC, Bruno MJ, et al. Acid suppression and surgical therapy for Barrett's oesophagus. Best Pract Res Clin Gastroenterol. 2015 Feb;29(1):139-50. PubMed  
  27. Jankowski JAZ, de Caestecker J, Love SB, et al. Esomeprazole and aspirin in Barrett's oesophagus (AspECT): a randomised factorial trial. Lancet. 2018 Aug 4;392(10145):400-408. doi: 10.1016/S0140-6736(18)31388-6. Epub 2018 Jul 26. (Original) PMID: 30057104 PubMed  
  28. Kastelein F, Spaander MC, Biermann K, Steyerberg EW et al. Nonsteroidal anti-inflammatory drugs and statins have chemopreventative effects in patients with Barrett's esophagus. PMID: 21878200 PubMed  
  29. Desai TK, Krishnan K, Samala N, Singh J, Cluley J, Perla S, Howden CW. The incidence of oesophageal adenocarcinoma in non-dysplastic Barrett's oesophagus: a meta-analysis. Gut. 2012 Jul;61(7):970-6. doi: 10.1136/gutjnl-2011-300730. Epub 2011 Oct 13. PMID: 21997553 PubMed  
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet
  • Ingard Løge, spesialist allmennmedisin (NEL)